Protein-losing enteropathy in a paediatric patient with Kawasaki disease: a rare clinical manifestation

Kawasaki disease (KD) is an acute vasculitis of childhood, which can lead to complications affecting multiple organ systems. Protein-losing enteropathy (PLE) is an extremely rare complication of KD, characterised by excessive protein loss through the gastrointestinal tract, leading to hypoalbuminaemia, oedema and immune dysfunction. We report a case of an early childhood boy with intravenous immune globulin (IVIG)-resistant incomplete KD who developed PLE. The patient presented with prolonged fever, conjunctivitis, mucosal changes and cervical lymphadenopathy. He subsequently developed generalised oedema, hypoalbuminaemia and pleural effusion. Diagnosis of PLE was confirmed by elevated stool alpha-1 antitrypsin levels. The patient improved with a second dose of IVIG and supportive therapy. This case highlights the importance of recognising PLE as a potential complication of KD and the importance of early diagnosis and proper treatment to reduce the risk of adverse sequelae.