A Case Of Kawasaki Disease Complicated By Autoimmune Hemolytic Anemia In A Boy

Introduction: Kawasaki disease is a systematic disease, usually affecting infants and toddlers. It can be characterized by rare complications or by unusual associations. One of these is autoimmune hemolytic anemia that has been observed seldom up to now. In this report, we present a case with this rare association.Case: A previous healthy 7-year-old boy was transferred form a primary clinic due to fever and neck mass. Neck CT showed acute pharyngitis with focal abscess formation and multiple enlarged lymph nodes at both retropharyngeal space. He was treated intravenous antibiotics for 3 days. On the 4th hospital days, the patient sustained high fever and presented diffuse maculopapular rash, conjunctival injection without exudate, erythema and edema of the hands and feet. Laboratory finding showed Hb 11.6 g/dL; hematocrit (Hct) 33.9 %; WBC count 15,350 μL; platelets count 308,000 μL; AST 123 IU/L; ALT 237 IU/L; CRP 103.14 mg/L; creatinine kinase (CK) 28 IU/L; CK-MB 0.6 ng/mL; pro-BNP 783.2 pg/mL. Mild dilatation of right coronary artery (4.14mm) was noted in echocardiogram. The patient was diagnosed Kawasaki disease and treated intravenous immunoglobulin (IVIG) (2g/kg) and aspirin. Retreatment with IVIG was administered for persistence of fever 48 hours after the first infusion. Thereafter, his symptoms gradually improved. On the 12th hospital day, his follow-up laboratory finding showed decreased Hb 7.1 g/dL and Hct 20.8 %; reticulocyte 10.71 %; peripheral blood smear: normocytic normochromic anemia with anisopoikilocytosis, immune hemolytic anemia; Direct polyspecific antiglobulin test positive. There was no hemodynamic instability. Prednisolone 2mg/kg/day P.O. was given for hemolytic anemia and hemolysis resolved following treatment. On follow-up, hemoglobin and hematocrit increased gradually. He made a good clinical recovery without cardiovascular complication.Conclusion: A 7-year-old boy presented with the fever, skin rash, conjunctival injection and lymphadenopathy. He was diagnosed Kawasaki disease. Autoimmune hemolytic anemia occur on the way of improving state after treatment. The authors report a case of autoimmune hemolytic anemia during Kawasaki disease