Kawasaki disease presenting with lymphadenopathy and gastrointestinal hemorrhage: report of one case.

We report a 5-year-old boy with Kawasaki disease (KD) initially presenting with cervical lymphadenitis and complicated by gastrointestinal hemorrhage before the use of salicylates (aspirin). A previously well and fully immunized 5-year-old Japanese boy presented with a 5-day history of neck mass and fever. Physical examination showed bilateral lymphadenopathy but not nonexudative conjunctivitis, oral cavity changes, skin rash, or extremity changes. He was admitted with a diagnosis of neck lymphadenitis and treated with parenteral antibiotics. Tarry stool was noted on the second day of admission, before the definitive diagnosis of KD was made, and cimetidine was given to treat the gastrointestinal hemorrhage. On the fourth day of admission, he fulfilled the diagnostic criteria for KD (fever for 9 days plus lymphadenopathy, lip fissure, conjunctivitis, and skin rash). He was treated with intravenous immunoglobulin (2 g/kg/day) and aspirin (80 mg/kg/day), and the fever subsided promptly. Massive gastrointestinal bleeding occurred on the ninth day of admission and was treated with whole blood transfusion, after which the vital signs were stable.