An Unusual Presentation of Kawasaki Disease; Hepatobiliary Involvement: Report of Two Cases

Kawasaki disease is an acute systemic vasculitis that can affect almost all organs. Because of the serious cardiac complications of the disease, early diagnosis and treatment are extremely important. The diagnosis is based on the presence of characteristic clinical findings. Jaundice due to direct hyperbilirubinemia is a rare manifestation of the disease. Acute cholestasis and gallbladder hydrops are not only clinical features but also atypical initial symptoms of the disease as has also been reported. Liver involvement ranges from mild asymptomatic increase in liver enzymes to a severe cholestatic hepatitis and/or hydrops of the gallbladder. This clinical presentation may cause diagnostic dilemma and delay the initiation of treatment. Kawasaki disease should be borne in mind in patients who present with fever, vomiting, abdominal pain, jaundice, and long-lasting fever, and should be eveluated with echocardiogphy for the coronary artery involvement. Here, we report two cases of typical Kawasaki disease who initially presented with hepatobiliary involvement, subsequently developed typical Kawasaki disease signs and responded well to the medical treatment.