Table 1 Time line of events
From: Kawasaki disease presenting after intussusception: a case report
Date | Summary from initial and follow-up visits | Diagnostic testing | Intervention |
|---|---|---|---|
April 2019 Day 1 | One-day history of vomiting and mucoid bloody stool. On examination, gloved finger stained with mucoid feces mixed with streaks of fresh blood. Diagnosis: possible intussusception | CRP 3.05 mg/L, WBC: 16.13 × 109/L, platelets: 466 × 109/L, Hb: 10.7 g/dL, abdominal ultrasound: target sign at right upper quadrant with peripheral vascularity | Laparotomy and manual reduction of the intussusception. Initiation of ceftriaxone and metronidazole |
Day 3 | Child doing well | Discharged on cefixime and metronidazole | |
Day 4 | High-grade fevers and diarrhea. Examination: irritable, febrile, tachycardic with some dehydration, no lymphadenopathy, delayed capillary refill with peripheral cyanosis, and maculopapular rash on the back and at BCG scar site. Hyperactive bowel sounds and clean surgical wound. Diagnosis: sepsis | CRP: 121 mg/L, WBC: 16.83 × 10, platelets: 428 × 109/L, Hb: 9.1 g/dL 9/L, stool routine, urine routine: normal Abdominal X-ray: normal | IV amikacin + IV ceftriaxone + IV metronidazole IV fluid bolus, then IV DNS at maintenance rate, zinc sulfate 20 mg, ibuprofen, and paracetamol |
Day 5 | Persistent fever and irritability, nonpitting feet swelling, bilateral nonpurulent conjunctivitis sparing the limbus | Dengue serology: negative | Antibiotics continued |
Day 6 | Persistent fever erythematous change of the tongue, dry cracked and bleeding lips. Diagnosis: Kawasaki disease | WBC: 8 × 109/L, platelets: 316 × 109/L, Hb: 8.6 g/dL CRP: 182 mg/L Echocardiogram: normal | IV immunoglobulin at 2 g/kg and low-dose aspirin at 3 mg/kg/day |
Day 7 | Fever resolved | Discharged on low-dose aspirin | |
May 2019 | Follow-up visit: no signs and symptoms | Normal echocardiogram and CRP | Aspirin stopped |