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Kawasaki disease (KD), also referred to as mucocutaneous lymph node syndrome and infantile polyarteritis nodosa, is characterized by inflammation of small and medium-sized blood vessels across the body. It can manifest in various clinical features among pediatric patients admitted to general pediatric departments with fever, particularly those aged less than 5 years. Despite its relatively benign nature, it is crucial to promptly identify potential complications. We describe the case of a 10-month-old female patient admitted to the general pediatric department due to a 5-day history of fever peaking at 40.5⁰C, diarrhea, and irritability. Physical examination revealed no conjunctivitis, cervical lymphadenopathy, or rash, but notable irritability and edematous induration on the dorsum of her hands and feet. Initial laboratory investigations showed elevated acute phase reactants, and radiological assessment indicated terminal ileitis. Considering the presentation consistent with incomplete KD, characterized by persistent fever, ill appearance, ileitis, hypoalbuminemia, and elevated acute phase reactants, we pursued further evaluation. Echocardiography revealed ecstatic and prominent coronary artery without dilation of the main coronary arteries. It is important to recognize that not all KD patients will exhibit all typical features, and presentations may vary. While inflammatory changes in multiple systems have been documented in KD, terminal ileitis has not been previously reported in pediatric patients. [ABSTRACT FROM AUTHOR]

Introduction: Heart transplantation (HT) is the only treatment option in children with heart failure secondary to cardiomyopathies and non-reparable congenital heart diseases., Methods: We performed a retrospective clinical data review of all consecutive pediatric patients (aged 2-18 years) who underwent orthotopic HT for advanced heart failure at our institution between January 2007 and January 2023. Clinical, procedural, and follow-up data were collected and comprehensively analyzed., Results: We identified 27 children (66.7% males) with a median age of 15 years (IQR: 7-16) and a median weight of 45 kg (IQR: 22-66) at the time of the intervention. 24 patients (88.8%) were diagnosed with dilated cardiomyopathy, 2 (7.4%) with restrictive cardiomyopathy, and 1 (3.7%) with hypertrophic cardiomyopathy. On a median follow-up of 35.07 months (IQR: 13.13-111.87), arrhythmias were detected in 9 (33%) patients. Three patients developed symptomatic sinus node dysfunction at 18, 25, and 38 days and received permanent pacemakers. One patient developed a complete AV block during acute rejection at 76 months and received a temporary pacemaker. Two patients developed chronic sinus tachycardia at 4 and 16 months and were treated with Beta-blockers after eliminating all causes of sinus tachycardia. One patient developed a complete right bundle branch block at 12 months. One patient developed ventricular extrasystole at 10 months and was found to have grade 2 rejection. An Atrial extrasystole was detected in one patient at 96 months. We did not identify significant risk factors for arrhythmias post-HT., Discussion: After pediatric HT, early-onset rhythm disturbances, often attributed to surgery-related issues such as sinus node dysfunction, may necessitate invasive treatments like permanent pacemaker therapy. Close monitoring post-transplantation is crucial, and routine follow-up with Holter ECG is necessary to identify potential rhythm disorders even in the absence of symptoms. Rhythm disturbances that develop during follow-up can serve as early indicators of graft rejection and should be carefully evaluated., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Doğan, Ergin, Beyter, Kaşıkçı, Ön, Ay, Levent, Engin and Ülger.)