{"paper_id":"4babeb1f-e3bf-4d8b-a4cd-ff9573e699da","body_text":"Kawasaki disease with cardiac involvement revealed by acute pancreatitis in an adult: A rare case report. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Kawasaki disease with cardiac involvement revealed by acute pancreatitis in an adult: A rare case report. Leila BARAKAT, Meryem HABOUB, Safaa MHABER, Khadija ECHCHILALI, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5228090/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 May, 2025 Read the published version in The Egyptian Heart Journal → Version 1 posted 4 You are reading this latest preprint version Abstract Background: Kawasaki disease (KD) is a rare systemic inflammatory disease primarily affecting children under 5 years of age, with very few cases reported in adults. This condition is characterized by potential coronary involvement, including aneurysms and gastrointestinal manifestations, such as pancreatitis. Case Presentation: A 21-year-old man presented with a febrile rash, fever, conjunctivitis, and acute pancreatitis. Imaging revealed coronary artery aneurysms. Treatment with intravenous immunoglobulins, aspirin, and corticosteroids led to significant clinical improvement. Conclusions: This case underscores the rare occurrence of Kawasaki disease in adults, particularly with both pancreatic and coronary artery involvement. The effective use of immunoglobulins and corticosteroids highlights the importance of early diagnosis and treatment in managing this rare condition in adults. Kawasaki disease Acute pancreatitis Coronary aneurysm Systemic vasculitis Intravenous immunoglobulins Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 BACKGROUND Kawasaki disease (KD) is a rare systemic inflammatory disease that primarily affects children under 5 years of age [ 1 ]. The incidence of adult-onset KD is extremely low, with only approximately 100 cases reported to date [ 2 ]. Coronary involvement is the most common complication of the disease and manifests as aneurysm, calcification, or vascular stenosis [ 3 ]. Gastrointestinal manifestations are uncommon in Kawasaki disease, and pancreatitis has been exceptionally reported in adults [ 4 ]. CASE PRESENTATION A 21-year-old man with no significant medical history, recent medication intake, or infectious episode was referred to the internal medicine department for an etiological assessment of a febrile rash. The clinical presentation had been evolving for 20 days and was initially characterized by a febrile maculopapular rash at 39°C, rapidly accompanied by edema of the extremities, bilateral conjunctivitis (Fig. 1 ), and cheilitis (Fig. 2 ). The clinical presentation was further complicated by the onset of acute pancreatitis 6 days later, manifested by abdominal pain, a lipase level elevated to 6 times the normal value, and a computed tomography (CT) scan showing features consistent with stage C pancreatitis. Laboratory tests revealed elevated inflammatory markers with a C-reactive protein level of 160 mg/L. The infectious workup was negative. The evolution was marked by diffuse desquamation of the trunk (Fig. 3 ) and extremities (Fig. 4 ). Transthoracic echocardiography showed normal ventricles and atria, no valvular heart disease, no aortic dilatation, mild pericardial effusion behind the right atrium (Fig. 5 ), and a coronary artery aneurysm. The proximal right coronary artery measured 10 mm (Fig. 6 ), the left main coronary artery was dilated to 9 mm, the left anterior descending artery was dilated to 6 mm (Fig. 7 ), and the circumflex artery was dilated to 8 mm (Fig. 8 ). Coronary angiography revealed images in the left anterior oblique (LAO) cranial view at 30°/30° showing an aneurysmal common trunk and proximal left anterior descending artery (LAD). Images in the right anterior oblique (RAO) caudal view at 30°/30° showed a slightly aneurysmal circumflex artery. Images in the strict cranial view revealed the right coronary artery with multiple aneurysms in all segments (red arrows in Fig. 9 ). Kawasaki disease (KD) was diagnosed, and the patient was treated with intravenous immunoglobulins (IVIG) combined with aspirin and a bolus of methylprednisolone 1 g for three days, followed by high-dose oral corticosteroids for 4 weeks, after which the symptoms gradually subsided. The clinical and biological evolution was favorable, with disappearance of the inflammatory syndrome after 15 days of treatment. DISCUSSION Kawasaki disease (KD) is a systemic inflammatory condition of uncertain origin that predominantly affects children under five years of age. The exact cause of Kawasaki disease remains unknown, although seasonal episodes, particularly in summer and winter, suggest the possibility of an infectious trigger. Diagnostic criteria for adult Kawasaki disease have also been proposed [ 5 ]. The diagnosis is probable if an individual presents with unexplained persistent fever for more than 5 days with an onset age of first manifestations over 18 years, along with coronary involvement and 3 out of 5 criteria, which are as follows: i) exanthema; ii) oral mucosal changes; iii) extremity changes; iv) conjunctivitis; v) lymphadenopathy. Our patient met four criteria in addition to prolonged fever and coronary involvement, which was sufficient to establish a diagnosis of Kawasaki disease. Pericarditis is a common but under-reported manifestation. It is typically mild and asymptomatic [ 6 ]. Digestive involvement was also possible. Common gastrointestinal signs include abdominal pain, diarrhea, hepatitis, vomiting, and gallbladder hydrops; jaundice and pancreatitis are less common [ 7 ]. Histological pancreatic involvement has been commonly observed in autopsy reports, but clinical pancreatitis remains rare [ 8 ]. Pancreatitis in Kawasaki disease is characterized by vasculitis of the medium-sized arteries and veins. The beneficial effects of IV Ig in Kawasaki disease complicated by pancreatitis have been previously explained by the resolution of vasculitis in pancreatic blood vessels [ 9 ]. A literature review highlighted that pancreatitis can precede the onset of Kawasaki disease symptoms, be part of the clinical picture of the disease, or even occur several days after IgIV administration. Abdominal pain is the most common symptom of pancreatic involvement, although some patients remain asymptomatic and only exhibit elevated lipase levels [ 10 ]. Only two cases of Kawasaki disease in adults with pancreatitis have been reported in the literature [ 8 , 11 ], and to date, no cases have been described in adults presenting with both pancreatitis and coronary artery aneurysm. The recommended treatment regimen for Kawasaki disease is a single infusion of 2 g/kg of IVIG, which may be repeated in cases of resistance defined by persistent or recurrent fever after 36 h [ 3 ]. Treatment should be initiated promptly, preferably before the 10th day following the onset of the disease, as long as the inflammation persists. However, diagnosis within the first 10 days of the disease is rare and often results in delayed treatment initiation [ 12 ]. Corticosteroids are commonly prescribed for most vasculitides because of their rapid action, potent anti-inflammatory properties, and generally positive outcomes. Their use in Kawasaki disease treatment is more debated, but emerging data suggest that patients at high risk of developing coronary artery aneurysms may benefit from early initiation of corticosteroids in addition to IVIG and aspirin [ 1 ]. Although the diagnosis was made 20 days after the onset of the first symptoms, a bolus of methylprednisolone was administered to our patient because of the presence of two severe manifestations, pancreatic and cardiac, in combination with immunoglobulins and aspirin. CONCLUSION This case highlights the exceptional occurrence of Kawasaki disease in an adult, marked by simultaneous pancreatic and coronary artery involvement. The successful administration of intravenous immunoglobulins and corticosteroids resulted in significant clinical improvement, emphasizing the need for increased awareness and prompt recognition of this rare condition in adult patients. Abbreviations KD Kawasaki disease CT computed tomography CRP C-reactive protein LAO left anterior oblique LAD left anterior descending RAO right anterior oblique IVIG intravenous immunoglobulins Declarations Ethics approval and consent to participate Ethical approval was exempted by the Ethical Committee at Ibn Roch university hospital for reporting this case. Consent for publication Written informed consent was obtained from the patient for the publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request. Funding None. Author Contribution Dr B.L. and M.S. conducted the literature review. Dr B.L. designed and wrote the manuscript. Dr H.M. provided us with the iconography and titled the figures. Dr E.K., M.M., E.H. revised the literature review. Dr D.A., A.S., B.M.G., and H.R. wrote the cardiological part. All authors reviewed the manuscript. References Rife E, Gedalia A. Kawasaki Disease: an Update. Curr Rheumatol Rep 2020; 22: 75. Maeda K, Marutani S, Nishi K, et al. Two Cases of Adult-onset Kawasaki Disease with a Difficult Diagnosis. Intern Med 2023; 62: 3157–3161. Datta AK, Debnath P, Chaudhuri J, et al. Adult-onset Kawasaki disease: A great masquerader. BMJ Case Rep 2021; 14: e239746. Lee W, Cheah CS, Suhaini SA, et al. Clinical Manifestations and Laboratory Findings of Kawasaki Disease: Beyond the Classic Diagnostic Features. Medicina (Mex) 2022; 58: 734. Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2004; 110: 2747–2771. Pilania RK, Jindal AK, Bhattarai D, et al. Cardiovascular Involvement in Kawasaki Disease Is Much More Than Mere Coronary Arteritis. Front Pediatr 2020; 8: 526969. McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. Circulation 2017; 135: e927–e999. Albert D, Ally M, Ally M. Kawasaki Disease Complicated by Pancreatitis in an Adult. Off J Am Coll Gastroenterol ACG 2014; 109: S287. Prokic D, Ristic G, Paunovic Z, et al. Pancreatitis and atypical Kawasaki disease. Pediatr Rheumatol Online J 2010; 8: 8. Botti M, Costagliola G, Consolini R. Typical Kawasaki Disease Presenting With Pancreatitis and Bilateral Parotid Gland Involvement: A Case Report and Literature Review. Front Pediatr 2018; 6: 90. Maczyta A, Zordan J, Despres J, et al. Forme rare de maladie de Kawasaki post-SARS-CoV-2, avec orchite et pancréatite, chez un adulte. Rev Médecine Interne 2021; 42: A121–A122. Kontopoulou T, Kontopoulos DG, Vaidakis E, et al. Adult Kawasaki disease in a European patient: a case report and review of the literature. J Med Case Reports 2015; 9: 75. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 26 May, 2025 Read the published version in The Egyptian Heart Journal → Version 1 posted Editorial decision: Revision requested 17 Oct, 2024 Editor assigned by journal 10 Oct, 2024 Submission checks completed at journal 10 Oct, 2024 First submitted to journal 08 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-5228090\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Case Report\",\"associatedPublications\":[],\"authors\":[{\"id\":367407115,\"identity\":\"5513e258-8a60-43ee-8d28-7d7737eaedbc\",\"order_by\":0,\"name\":\"Leila 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23:08:14\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-5228090/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-5228090/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1186/s43044-025-00649-9\",\"type\":\"published\",\"date\":\"2025-05-26T15:57:23+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":68046231,\"identity\":\"513ff255-a42e-461c-b07d-c410da9e7c63\",\"added_by\":\"auto\",\"created_at\":\"2024-11-01 18:06:49\",\"extension\":\"jpg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":39505,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eBilateral conjunctivitis.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure1.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5228090/v1/aaed466c39cd055018ed529d.jpg\"},{\"id\":68046233,\"identity\":\"b06dac94-1eaa-4147-895d-4e89fe7004f4\",\"added_by\":\"auto\",\"created_at\":\"2024-11-01 18:06:49\",\"extension\":\"jpg\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":21995,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eCheilitis\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure2.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5228090/v1/8cfe442cbfdf6786cd33c872.jpg\"},{\"id\":68046008,\"identity\":\"575afccc-39a9-4e33-b77c-48160994f339\",\"added_by\":\"auto\",\"created_at\":\"2024-11-01 17:58:49\",\"extension\":\"jpg\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":262149,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eDiffuse desquamation of the trunk.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure3.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5228090/v1/43d2f42e204b2687dc1e91db.jpg\"},{\"id\":68046011,\"identity\":\"b034e7df-73fb-44b0-9a1b-041024cca8cb\",\"added_by\":\"auto\",\"created_at\":\"2024-11-01 17:58:50\",\"extension\":\"jpg\",\"order_by\":4,\"title\":\"Figure 4\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":85446,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eDesquamation of extremities.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure4.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5228090/v1/ff2e0c4fb31e18d219e7aef6.jpg\"},{\"id\":68046006,\"identity\":\"6707cf47-2849-4a31-b6c1-427bd3221a95\",\"added_by\":\"auto\",\"created_at\":\"2024-11-01 17:58:49\",\"extension\":\"jpg\",\"order_by\":5,\"title\":\"Figure 5\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":51490,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eMild pericardial effusion behind the right atrium.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure5.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5228090/v1/ba1cbed91f531cdd4edc727a.jpg\"},{\"id\":68046232,\"identity\":\"1446caa6-e2c3-4686-bdd1-0dfe04d426f4\",\"added_by\":\"auto\",\"created_at\":\"2024-11-01 18:06:49\",\"extension\":\"jpg\",\"order_by\":6,\"title\":\"Figure 6\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":37607,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eDilation of the proximal right coronary artery measuring 10 mm\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure6.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5228090/v1/4cb7802cbe2340737744375a.jpg\"},{\"id\":68046004,\"identity\":\"0b24622f-37b8-4f14-93ff-cc94d2e9c844\",\"added_by\":\"auto\",\"created_at\":\"2024-11-01 17:58:49\",\"extension\":\"jpg\",\"order_by\":7,\"title\":\"Figure 7\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":52015,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eDilation of the left anterior descending artery measuring 6 mm.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure8.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5228090/v1/d3b68aa332f5e4bac5121c80.jpg\"},{\"id\":68046012,\"identity\":\"612173bb-297d-40d8-8fc2-9c850ba1d47b\",\"added_by\":\"auto\",\"created_at\":\"2024-11-01 17:58:50\",\"extension\":\"jpg\",\"order_by\":8,\"title\":\"Figure 8\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":34778,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eDilation of the circumflex artery measuring 8 mm.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure7.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5228090/v1/f2c76a3ea2893011d98a6010.jpg\"},{\"id\":68046010,\"identity\":\"9263c703-0531-43f0-933a-c4d51c3c8231\",\"added_by\":\"auto\",\"created_at\":\"2024-11-01 17:58:50\",\"extension\":\"png\",\"order_by\":9,\"title\":\"Figure 9\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":334609,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eImages in the strict cranial view revealed the right coronary artery with multiple aneurysms in all segments (red arrows).\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure9.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5228090/v1/aa53f0c30f35c5b280b460e9.png\"},{\"id\":83782874,\"identity\":\"f6c89897-83db-40fc-b862-9279edec868a\",\"added_by\":\"auto\",\"created_at\":\"2025-06-02 16:07:52\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1431426,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5228090/v1/822c46ce-cb27-4fe8-9265-593985d92a8c.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\" Kawasaki disease with cardiac involvement revealed by acute pancreatitis in an adult: A rare case report. \",\"fulltext\":[{\"header\":\"BACKGROUND\",\"content\":\"\\u003cp\\u003eKawasaki disease (KD) is a rare systemic inflammatory disease that primarily affects children under 5 years of age [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. The incidence of adult-onset KD is extremely low, with only approximately 100 cases reported to date [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. Coronary involvement is the most common complication of the disease and manifests as aneurysm, calcification, or vascular stenosis [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. Gastrointestinal manifestations are uncommon in Kawasaki disease, and pancreatitis has been exceptionally reported in adults [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e].\\u003c/p\\u003e \"},{\"header\":\"CASE PRESENTATION\",\"content\":\"\\u003cp\\u003eA 21-year-old man with no significant medical history, recent medication intake, or infectious episode was referred to the internal medicine department for an etiological assessment of a febrile rash. The clinical presentation had been evolving for 20 days and was initially characterized by a febrile maculopapular rash at 39\\u0026deg;C, rapidly accompanied by edema of the extremities, bilateral conjunctivitis (Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e), and cheilitis (Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). The clinical presentation was further complicated by the onset of acute pancreatitis 6 days later, manifested by abdominal pain, a lipase level elevated to 6 times the normal value, and a computed tomography (CT) scan showing features consistent with stage C pancreatitis. Laboratory tests revealed elevated inflammatory markers with a C-reactive protein level of 160 mg/L. The infectious workup was negative. The evolution was marked by diffuse desquamation of the trunk (Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e) and extremities (Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e).\\u003c/p\\u003e\\n\\u003cp\\u003eTransthoracic echocardiography showed normal ventricles and atria, no valvular heart disease, no aortic dilatation, mild pericardial effusion behind the right atrium (Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e), and a coronary artery aneurysm. The proximal right coronary artery measured 10 mm (Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e6\\u003c/span\\u003e), the left main coronary artery was dilated to 9 mm, the left anterior descending artery was dilated to 6 mm (Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e7\\u003c/span\\u003e), and the circumflex artery was dilated to 8 mm (Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e8\\u003c/span\\u003e). Coronary angiography revealed images in the left anterior oblique (LAO) cranial view at 30\\u0026deg;/30\\u0026deg; showing an aneurysmal common trunk and proximal left anterior descending artery (LAD). Images in the right anterior oblique (RAO) caudal view at 30\\u0026deg;/30\\u0026deg; showed a slightly aneurysmal circumflex artery. Images in the strict cranial view revealed the right coronary artery with multiple aneurysms in all segments (red arrows in Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e9\\u003c/span\\u003e).\\u003c/p\\u003e\\n\\u003cp\\u003eKawasaki disease (KD) was diagnosed, and the patient was treated with intravenous immunoglobulins (IVIG) combined with aspirin and a bolus of methylprednisolone 1 g for three days, followed by high-dose oral corticosteroids for 4 weeks, after which the symptoms gradually subsided. The clinical and biological evolution was favorable, with disappearance of the inflammatory syndrome after 15 days of treatment.\\u003c/p\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eKawasaki disease (KD) is a systemic inflammatory condition of uncertain origin that predominantly affects children under five years of age. The exact cause of Kawasaki disease remains unknown, although seasonal episodes, particularly in summer and winter, suggest the possibility of an infectious trigger. Diagnostic criteria for adult Kawasaki disease have also been proposed [\\u003cspan class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e].\\u003c/p\\u003e\\n\\u003cp\\u003eThe diagnosis is probable if an individual presents with unexplained persistent fever for more than 5 days with an onset age of first manifestations over 18 years, along with coronary involvement and 3 out of 5 criteria, which are as follows: i) exanthema; ii) oral mucosal changes; iii) extremity changes; iv) conjunctivitis; v) lymphadenopathy. Our patient met four criteria in addition to prolonged fever and coronary involvement, which was sufficient to establish a diagnosis of Kawasaki disease.\\u003c/p\\u003e\\n\\u003cp\\u003ePericarditis is a common but under-reported manifestation. It is typically mild and asymptomatic [\\u003cspan class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]. Digestive involvement was also possible. Common gastrointestinal signs include abdominal pain, diarrhea, hepatitis, vomiting, and gallbladder hydrops; jaundice and pancreatitis are less common [\\u003cspan class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. Histological pancreatic involvement has been commonly observed in autopsy reports, but clinical pancreatitis remains rare [\\u003cspan class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. Pancreatitis in Kawasaki disease is characterized by vasculitis of the medium-sized arteries and veins. The beneficial effects of IV Ig in Kawasaki disease complicated by pancreatitis have been previously explained by the resolution of vasculitis in pancreatic blood vessels [\\u003cspan class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. A literature review highlighted that pancreatitis can precede the onset of Kawasaki disease symptoms, be part of the clinical picture of the disease, or even occur several days after IgIV administration. Abdominal pain is the most common symptom of pancreatic involvement, although some patients remain asymptomatic and only exhibit elevated lipase levels [\\u003cspan class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. Only two cases of Kawasaki disease in adults with pancreatitis have been reported in the literature [\\u003cspan class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e], and to date, no cases have been described in adults presenting with both pancreatitis and coronary artery aneurysm.\\u003c/p\\u003e\\n\\u003cp\\u003eThe recommended treatment regimen for Kawasaki disease is a single infusion of 2 g/kg of IVIG, which may be repeated in cases of resistance defined by persistent or recurrent fever after 36 h [\\u003cspan class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. Treatment should be initiated promptly, preferably before the 10th day following the onset of the disease, as long as the inflammation persists. However, diagnosis within the first 10 days of the disease is rare and often results in delayed treatment initiation [\\u003cspan class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. Corticosteroids are commonly prescribed for most vasculitides because of their rapid action, potent anti-inflammatory properties, and generally positive outcomes. Their use in Kawasaki disease treatment is more debated, but emerging data suggest that patients at high risk of developing coronary artery aneurysms may benefit from early initiation of corticosteroids in addition to IVIG and aspirin [\\u003cspan class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. Although the diagnosis was made 20 days after the onset of the first symptoms, a bolus of methylprednisolone was administered to our patient because of the presence of two severe manifestations, pancreatic and cardiac, in combination with immunoglobulins and aspirin.\\u003c/p\\u003e\"},{\"header\":\"CONCLUSION\",\"content\":\"\\u003cp\\u003eThis case highlights the exceptional occurrence of Kawasaki disease in an adult, marked by simultaneous pancreatic and coronary artery involvement. The successful administration of intravenous immunoglobulins and corticosteroids resulted in significant clinical improvement, emphasizing the need for increased awareness and prompt recognition of this rare condition in adult patients.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cdiv class=\\\"DefinitionList\\\"\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eKD\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eKawasaki disease\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eCT\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003ecomputed tomography\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eCRP\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eC-reactive protein\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eLAO\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eleft anterior oblique\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eLAD\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eleft anterior descending\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eRAO\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eright anterior oblique\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eIVIG\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eintravenous immunoglobulins\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\" \\u003cp\\u003e \\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e \\u003cp\\u003eEthical approval was exempted by the Ethical Committee at Ibn Roch university hospital for reporting this case.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e \\u003cp\\u003e Written informed consent was obtained from the patient for the publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.\\u003c/p\\u003e \\u003c/p\\u003e\\u003ch2\\u003eFunding\\u003c/h2\\u003e \\u003cp\\u003eNone.\\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eDr B.L. and M.S. conducted the literature review. Dr B.L. designed and wrote the manuscript. Dr H.M. provided us with the iconography and titled the figures. Dr E.K., M.M., E.H. revised the literature review. Dr D.A., A.S., B.M.G., and H.R. wrote the cardiological part. All authors reviewed the manuscript.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eRife E, Gedalia A. Kawasaki Disease: an Update. Curr Rheumatol Rep 2020; 22: 75.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMaeda K, Marutani S, Nishi K, et al. Two Cases of Adult-onset Kawasaki Disease with a Difficult Diagnosis. Intern Med 2023; 62: 3157\\u0026ndash;3161.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDatta AK, Debnath P, Chaudhuri J, et al. Adult-onset Kawasaki disease: A great masquerader. BMJ Case Rep 2021; 14: e239746.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLee W, Cheah CS, Suhaini SA, et al. Clinical Manifestations and Laboratory Findings of Kawasaki Disease: Beyond the Classic Diagnostic Features. Medicina (Mex) 2022; 58: 734.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eNewburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2004; 110: 2747\\u0026ndash;2771.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ePilania RK, Jindal AK, Bhattarai D, et al. Cardiovascular Involvement in Kawasaki Disease Is Much More Than Mere Coronary Arteritis. Front Pediatr 2020; 8: 526969.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMcCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. Circulation 2017; 135: e927\\u0026ndash;e999.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAlbert D, Ally M, Ally M. Kawasaki Disease Complicated by Pancreatitis in an Adult. Off J Am Coll Gastroenterol ACG 2014; 109: S287.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eProkic D, Ristic G, Paunovic Z, et al. Pancreatitis and atypical Kawasaki disease. Pediatr Rheumatol Online J 2010; 8: 8.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBotti M, Costagliola G, Consolini R. Typical Kawasaki Disease Presenting With Pancreatitis and Bilateral Parotid Gland Involvement: A Case Report and Literature Review. Front Pediatr 2018; 6: 90.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMaczyta A, Zordan J, Despres J, et al. Forme rare de maladie de Kawasaki post-SARS-CoV-2, avec orchite et pancr\\u0026eacute;atite, chez un adulte. Rev M\\u0026eacute;decine Interne 2021; 42: A121\\u0026ndash;A122.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKontopoulou T, Kontopoulos DG, Vaidakis E, et al. Adult Kawasaki disease in a European patient: a case report and review of the literature. J Med Case Reports 2015; 9: 75.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"the-egyptian-heart-journal\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"tehj\",\"sideBox\":\"Learn more about [The Egyptian Heart Journal](https://tehj.springeropen.com)\",\"snPcode\":\"43044\",\"submissionUrl\":\"https://submission.springernature.com/new-submission/43044/3\",\"title\":\"The Egyptian Heart Journal\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Springer Open\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Kawasaki disease, Acute pancreatitis, Coronary aneurysm, Systemic vasculitis, Intravenous immunoglobulins\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-5228090/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-5228090/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cb\\u003eBackground:\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003eKawasaki disease (KD) is a rare systemic inflammatory disease primarily affecting children under 5 years of age, with very few cases reported in adults. This condition is characterized by potential coronary involvement, including aneurysms and gastrointestinal manifestations, such as pancreatitis.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eCase Presentation:\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003eA 21-year-old man presented with a febrile rash, fever, conjunctivitis, and acute pancreatitis. Imaging revealed coronary artery aneurysms. Treatment with intravenous immunoglobulins, aspirin, and corticosteroids led to significant clinical improvement.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eConclusions:\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003eThis case underscores the rare occurrence of Kawasaki disease in adults, particularly with both pancreatic and coronary artery involvement. The effective use of immunoglobulins and corticosteroids highlights the importance of early diagnosis and treatment in managing this rare condition in adults.\\u003c/p\\u003e\",\"manuscriptTitle\":\" Kawasaki disease with cardiac involvement revealed by acute pancreatitis in an adult: A rare case report. \",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-11-01 17:58:45\",\"doi\":\"10.21203/rs.3.rs-5228090/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2024-10-17T21:43:19+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2024-10-10T09:25:24+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2024-10-10T09:24:59+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"The Egyptian Heart Journal\",\"date\":\"2024-10-08T23:04:20+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"the-egyptian-heart-journal\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"tehj\",\"sideBox\":\"Learn more about [The Egyptian Heart Journal](https://tehj.springeropen.com)\",\"snPcode\":\"43044\",\"submissionUrl\":\"https://submission.springernature.com/new-submission/43044/3\",\"title\":\"The Egyptian Heart Journal\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Springer Open\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"adf0680a-b364-43b9-ab9d-e217e84ff1eb\",\"owner\":[],\"postedDate\":\"November 1st, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-06-02T16:00:41+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-5228090\",\"link\":\"https://doi.org/10.1186/s43044-025-00649-9\",\"journal\":{\"identity\":\"the-egyptian-heart-journal\",\"isVorOnly\":false,\"title\":\"The Egyptian Heart Journal\"},\"publishedOn\":\"2025-05-26 15:57:23\",\"publishedOnDateReadable\":\"May 26th, 2025\"},\"versionCreatedAt\":\"2024-11-01 17:58:45\",\"video\":\"\",\"vorDoi\":\"10.1186/s43044-025-00649-9\",\"vorDoiUrl\":\"https://doi.org/10.1186/s43044-025-00649-9\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-5228090\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-5228090\",\"identity\":\"rs-5228090\",\"version\":[\"v1\"]},\"buildId\":\"J0_U0BvcaRcwD8yVFaRlm\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}