[A man presenting with fever and abdominal pain]

Abstract

A 34-year-old man with no previous medical history was referred to our surgical department with abdominal pain and fever. Over the next days he developed a cluster of symptoms, which finally led us in the right diagnostical direction. On admission he had clinical findings and biochemistry supportive of cholecystitis. However, he also had a non-symptomatic rash on his chest. Intravenous antibiotic treatment was instigated. Radiological findings did not show intraabdominal pathology, except for mesenterial lymphadenopathy. After three days on antibiotics the patient still had fever. The biochemical work-up revealed persistent cholestasis, lymphopenia and increasing infectious stigmata. A more extensive laboratory work-up was performed, including bacterial, viral, and immunological tests. During the next few days the patient developed palmar erythema, polymorphic exanthema, conjunctival bleeding and a strawberry tongue. The patient gradually improved, but developed skin desquamation, thrombocytosis and reactive arthralgia. This is consistent with the clinical picture of Kawasaki disease. As all supplemental tests were negative, we could therefore conclude (based on clinical, radiological and biochemical results) that this was a rare case of adult Kawasaki disease. A review of literature describing adult Kawasaki disease is also presented.