Gallbladder abnormalities in Kawasaki disease: a single-center case series study

Kawasaki disease is a systemic vasculitis predominantly affecting children, which can involve multiple organ systems, including the gallbladder. Gallbladder abnormalities in KD, particularly in incomplete cases with gastrointestinal symptoms, are often underdiagnosed. These abnormalities are associated with increased inflammation and resistance to intravenous immunoglobulin (IVIG) treatment. This study aims to enhance the understanding of the clinical features, diagnosis, treatment, and outcomes of gallbladder abnormalities in KD. Clinical data of children with Kawasaki disease (KD) complicated by gallbladder abnormalities admitted to the Children’s Hospital of Fudan University from 2016 to 2022 were retrospectively analyzed. A total of 15 children were enrolled, including 11 males and 4 females, with an average age of onset of 32 ± 20 months and an average diagnosis time of 6.4 ± 1.8 days. Nine children presented with gastrointestinal symptoms, including abdominal pain (4 cases), vomiting (4 cases), and diarrhea (2 cases). Five children had incomplete KD and were initially misdiagnosed. Laboratory findings showed elevated inflammatory markers and liver function tests, including increased total bilirubin (predominantly direct bilirubin), alanine aminotransferase, and γ-glutamyl transferase levels. Imaging revealed gallbladder enlargement in 14 cases and gallbladder wall thickening in 1 case; hepatomegaly was observed in 8 cases. All 15 patients received initial treatment with 2 g/kg IVIG, six patients also received glucocorticoids concurrently. Nine patients did not respond to the initial IVIG treatment. Secondary treatments included a second dose of IVIG (9 cases), 1–2 mg/kg glucocorticoids (6 cases), and 5–10 mg/kg glucocorticoids (2 cases). Eleven patients were treated with hepatoprotective and choleretic drugs, and one child underwent gallbladder drainage. Clinical symptoms improved in all children, with blood routine and biochemistry returning to normal. Eleven children were followed up with abdominal ultrasound, revealing normalization of the gallbladder at 2 months (range: 1 to 7 months) in 5 cases and reduction in size at 1 month in the remaining 6 cases. Gallbladder abnormalities in KD are often underdiagnosed, particularly in cases of incomplete KD presenting with gastrointestinal symptoms. These patients exhibit more severe inflammatory responses and a higher rate of IVIG resistance. Aggressive anti-inflammatory therapy leads to favorable outcomes in most cases, potentially avoiding the need for surgical intervention.