An adolescent with fever, jaundice, and abdominal pain: An unusual presentation of kawasaki disease

A 16-year-old boy presented with a 6-day history of fevers and myalgias and a 4-day history of diffuse crampy abdominal pain. On admission, his sclerae were icteric and he had diffuse abdominal tenderness. Erythrocyte sedimentation rate was elevated to 40; the γ-glutamyl transferase level was elevated to 168 U/L; indirect bilirubin was 5.6 mg/dL; and direct bilirubin was 3.3 mg/dL. During the next 2 days, he developed many stigmata of Kawasaki disease (KD), including conjunctivitis, desquamating rash, mucosal changes, swelling of the hands and feet, and lymphadenopathy. KD is commonly seen in young children but can also occur in adolescents and adults. Providers should be aware that these age-groups are at risk for KD and may present with atypical symptoms. Delays in diagnosis can put these adolescents at increased risk of coronary artery aneurysms, and, accordingly, a high index of suspicion is essential.