Autoimmune Haemolytic Anaemia: An Unusual Manifestation of Kawasaki Disease
Journal of Clinical and Diagnostic Research
A 10-month-old infant (with no significant past medical history) presented to the Department of Paediatrics with fever, diarrhoea and vomiting from past two days. He was pale, had an erythematous maculopapular rash all over the body, nonpurulent conjunctivitis, oedema of hands and feet; and dry, cracked and bleeding lips. Blood reports showed leucocytosis (16100/µL) and severe anaemia (Haemoglobin (Hb) 6.1 gm/dL). The initial laboratory reports are presented in the [Table/ Fig-1 ]. The
... g-1 ]. The provisional diagnosis at admission was rendered as acute gastroenteritis, malnutrition with severe anaemia and possible sepsis. Empirically, he was started on intravenous ceftriaxone (a dose of 75 mg/kg/day). On the second day of admission, his Hb had fallen to 4.8 gm%. A blood transfusion was planned; however, his blood would not cross-matching with the blood available in the blood bank. Direct and indirect Coombs test were positive (clumping of RBCs was seen). Also, hot and cold auto antibodies (IgG and IgM respectively) were detected in the blood sample, suggestive of AIHA. On the third day of admission, IVIg 1 gm/kg/ day for two days and intravenous dexamethasone at 0.2 mg/kg every eight hours, were started for AIHA. CONCLUSION One can speculate that both KD and AIHA are stimulated in susceptible persons by some common agent or maybe AIHA is a rare manifestation of KD. The exact aetiology of KD is not known even though there are many known causes for AIHA. The association between KD and AIHA may help, in the future, to elucidate the aetiology of KD.