DML Wong, YM Ng, SH Lee

Abstract

Children older than ten years with Kawasaki disease accounts for less than one percent of all the cases. We report an adolescent male with Kawasaki disease presenting with unusual but serious hepatorenal failure. A twelve-year-old boy presented with high fever, rash, bilateral conjunctivitis, jaundice and developed acute renal failure, impaired liver function test and impaired conscious state and was suspected to have systemic infection. He required intensive care support and haemofiltration therapy. Sepsis workup was negative. He was treated with intravenous antibiotics but there was no response. Echocardiogram performed on day 15 showed dilated and irregular coronary arteries of RCA and LCA, fair ventricular contractility and mild pericardial effusions. Diagnosis of Kawasaki disease was made and intravenous immunoglobulin was given on day 15 of fever. Fever persisted after the first dose of immunoglobulin and subsided nine days after second dose of immunoglobulin. Serial echocardiogram showed the development of giant aneurysm of RCA and LCA. Cardiac catheterisation showed presence of giant aneurysm of RCA and moderate size aneurysm of LCA.