On the fourth day of admission child became very sick, he was looking miserable, conjunctivae became red, developed measles like rash all over the body, lips cracked, tongue and buccal mucosa became intensively red and there was subcutaneous edema over palms and sole. Based on the foregoing clinical findings, he was diagnosed as Kawasaki disease; intravenous immunoglobulin was given along with oral aspirin- anti-inflammatory dose and supportive management maintaining the fluid and electrolyte balance. There was dramatic improvement clinically. Fever subsided within 24 hours of immunoglobulin infusion and urine output gradually improved and before discharge the renal parameters were returned to normal. He developed peeling of skin around the perianal area. An echocardiography done showed normal anatomy and function of the heart. Subsequently he was discharged on antiplatelet dose of aspirin and advised follow up. Echocardiography repeated two weeks after discharge showed right main coronary artery aneurysm of 5 mm in size. …show more content…
In both the published cases of KD and HUS, the HUS features were reported as complications of KD, while our case, the patient presented with clinical features of HUS hence making it the first reported case of such presentation. Luckily the patient showed typical features of KD on the 4th day of admission. On the contrary if the patient had not shown these features, there would have been delay in the diagnosis, with only on the features of HUS. Hemolytic uremic syndrome (HUS) is established as syndrome of heterogeneous group of correlative entities since 1955. In children it is considered as a predominant cause of community acquired acute renal failure. Statistics disclose that the probability of occurrence of HUS is one to three cases per 100,000 children per year16 .The three intrinsic features of HUS are microangiopathic hemolytic anemia, thrombocytopenia, and renal insufficiency