消化管および腎症状を伴う川崎病の異常な経過

Unusual Presentation Of Kawasaki Disease With Gastrointestinal And Renal Manifestations.

• Cecilia Lazea
• Oana Man
• Lucia Maria Sur
• Radu Serban
• Calin Lazar

抄録

川崎病（KD）の診断は、確立された臨床的基準に基づいて行われる。不完全または非定型のKDでは，臨床徴候が乏しいため，またはKDでは一般的に見られない臨床症状が存在するため，診断は困難である．持続的な高熱，嘔吐，水様下痢，代謝性アシドーシス，重度の低カリウム血症を呈した3歳女性患者の症例を紹介する．発熱4日目に両側結膜炎、粘膜、四肢の変化を登録した。尿には糖尿，蛋白尿などの変化がみられた．心エコー検査で左前下行冠動脈の異所性を認め，KDと診断された．治療は免疫グロブリンの静脈内投与とアスピリンの内服であった．再発は23日目に記録され，2回目のIVIG点滴後に良好な経過を示した。

Diagnosis of Kawasaki disease (KD) is based on well-established clinical criteria. In incomplete or atypical KD, the diagnosis is challenging, because of the paucity of clinical signs or because of the presence of clinical manifestations that generally are not seen in KD. We describe the case of a 3-year-old female patient with persistent high fever, vomiting, watery diarrhea, metabolic acidosis and severe hypopotassemia. On the fourth day of fever, bilateral conjunctivitis, mucous and extremity changes were registered. Urine changes as glycosuria and proteinuria were also noticed. Echocardiography revealed ectasia of the left anterior descending coronary artery, and diagnosis of KD was established. The treatment consisted of intravenous immunoglobulin (IVIG) and oral aspirin. Recurrence of disease was recorded on the 23rd day of the disease, with favorable evolution after the second dose of IVIG was infused.

© 2019 Lazea et al.