Gallbladder hydrops: when the clinical signs lead to the diagnosis of Kawasaki disease

Kawasaki disease (KD) is a vasculitis of the middle and little caliber arteries that specifically affects the coronary arteries. It represents the main cause of acquired cardiopathy in the pediatric population of western countries and in 25% of cases it leads to coronary artery aneurism (1). Atypical KD is nowadays considered a challenge for pediatrics, due to all of its possible clinical manifestations: it is characterized by a long-lasting fever (5 or more days) associated with some of the typical signs and symptoms and other unusual clinical manifestations (as neurological, nephrological, respiratory, gastrointestinal, rheumatological manifestations), variably associated with coronary arteries aneurism. Early diagnosis and treatment are essential to reduce the risk of coronary artery aneurysms (2,3). We report the case of a 5-year-old boy who came to our attention for skin rash, abdominal pain, increased liver enzymes, and hydrops of the gallbladder. He presented a fever for less than 5 days. 2 weeks later, the appearance of peeling on the fingers and the toes confirmed the diagnosis of an atypical, incomplete KD.