SFE2005 Poster Presentations Clinical case reports/Governance (21 abstracts)
Kawasaki disease in young adult with concomitant new onset of type I diabetes and autoimmunethyroiditis
G Singh , D Moll , S Hashmi , SJ Moses , M Engelbert , A Parnes , R Ahmadi , WN Pearson , A Huma & K Laudanski
Griffin Hospital, Derby, CT, United States.
This is a rare case of a previously healthy 21-year old Caucasian male (CM) diagnosed with a new onset of Kawasaki disease concomitant with diabetes mellitus and thyroiditis. He was admitted to ER with high fever (103.0F), generalized erythematous rash with desquamation of palms and soles, fissured lips, arthralgias, and malaise. Physical exam revealed anterior cervical lymph nodes enlargement on the right side. At the time of admission WBC=8300 cell/ml Eosinophil=6.2%, Hb/Hct=14 [g%]/41.8 [mm] ESR=45 [mm], Glucose=101 [mg%] Lipase=446 [IU/L], Alk phos=203 [IU/L], AST=107 [IU/L], Bilirubin=1.3 [mg%], ALT=327 [IU/L], free T4=4.5 [ng/dL], tT4=17.3 [ng/dL], TSH<0.01 [uIU/ml], ferritin=1539 [ng/ml]. Interestingly, several markers significantly evolved while patient was in the hospital such as: WBC (8300→17000) concomitantly with significant bands (17%), Hb/Hct=(14→6.2/41.82→8.4), Glucose (101→355→229→ 201→184 [mg%]), ESR (45→95), Eosinophils (6.2→10.9), and Ferritin (1539→2435). The further follow-up showed Anti-Thyroid Ab=1:400, GADS65=0.14 [nmol/L], Thyroid Peroxidase=161 [IU/ml], C-peptide=4.9 [ng/ml] but his ANA, ParvoB19, Monospot, RF, RPR, ASO, EBV, Hepatitis Panel and HIV were negative. CT exam showed superficial and deep cervical as well as mesenteric and retroperitoneal lymphadenopathy but insignificant changes in pancreas. Echocardiography showed dilatation of the proximal left coronary artery. His clinical condition improved after IVIG. He was diagnosed with Kawasaki disease, autoimmune thyroiditis, and diabetes type I and was treated with exogenous insulin and synthyroid. In our opinion this case represents an interesting, and previously unpublished, confluence of the autoimmune process leading to full symptomatic Kawasaki disease complicated by new onset of diabetes and thyroiditis.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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