Ewha Med J.  2015 Jul;38(2):80-84. 10.12771/emj.2015.38.2.80.

Atypical Kawasaki Disease Presenting as Acute Kidney Injury in a Patient with Influenza B Virus Infection

• Han YJ
• Kim SJ
• Cha JH
• Lee SJ
• Sohn S

• KMID: 2052786
• DOI: http://doi.org/10.12771/emj.2015.38.2.80

Abstract

Influenza virus infection is a common respiratory disease in children. Renal complications of influenza infection were not commonly encountered until the 2009 H1N1 influenza pandemic, when acute kidney injury (AKI) frequently developed in severely ill patients. Kawasaki disease (KD) is another rare association in pandemic influenza virus infections. There are some reports about KD coincident with influenza A H1N1/09 infection. However, simultaneous AKI and KD in influenza A or B virus infections have never been reported. Herein, we report the first case of influenza B virus infection that initially presented as AKI but was subsequently diagnosed as atypical KD.

Keyword

Influenza B virus; Mucocutaneous lymph node syndrome; Acute kidney injury

MeSH Terms

Acute Kidney Injury*
Child
Herpesvirus 1, Cercopithecine
Humans
Influenza B virus*
Influenza, Human
Mucocutaneous Lymph Node Syndrome*
Orthomyxoviridae
Pandemics

Figure

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  Fig. 1 (A) Initial chest radiograph. It shows hazy increased opacity suggesting pneumonia, and pulmonary edema in both lower lung fields. (B) Repeat chest radiography. It shows no residual lesions in both lungs.

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  Fig. 2 Renal ultrasonography. (A, B) It shows slightly increased cortical echogenicity of both kidneys, suggestive of renal parenchymal disease.

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  Fig. 3 Photographs of hand of foot on the 4th hospital day. It shows desquamation and peeling of fingers (A), toes and soles (B).

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  Fig. 4 The clinical course of the patient. The patient was initially diagnosed with influenza B virus infection and acute kidney injury after presenting with fever, cough, conjunctival injection, sore throat and skin rash followed by anuria. Diuresis occurred on the 3rd hospital day. Subsequently, periungual desquamation developed and intravenous immunoglobulin (IVIG) was administered under the diagnosis of Kawasaki disease.

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  Fig. 5 Serial changes in the estimated glomerular filtration rate (eGFR), serum creatinine (Cr), and albumin (alb) related to the hospital day (HD). A low eGFR and a high Cr at the time of admission were restored to within the normal range during the hospitalization.

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