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inyecci&#243;n conjuntival bilateral no purulenta&#44; adenomegalia cervical izquierda&#44; lengua &#171;aframbuesada&#187;&#44; eritema y descamaci&#243;n en dedos de manos y pies&#44; no se detect&#243; hepatomegalia&#44; su estado neurol&#243;gico y cardiorrespiratorio sin alteraciones&#44; frecuencia card&#237;aca de 85<span class="elsevierStyleHsp" style=""></span>lpm y presi&#243;n arterial de 90&#47;60<span class="elsevierStyleHsp" style=""></span>mmHg&#46; Los datos de laboratorio mostraron leucocitos 27&#46;330<span class="elsevierStyleHsp" style=""></span>c&#233;l&#47;&#956;l&#44; con neutr&#243;filos 26&#46;000<span class="elsevierStyleHsp" style=""></span>c&#233;l&#47;&#956;l y linfocitos 400<span class="elsevierStyleHsp" style=""></span>c&#233;l&#47;&#956;l&#44; plaquetas 364&#46;000<span class="elsevierStyleHsp" style=""></span>c&#233;l&#47;&#956;l&#44; velocidad de sedimentaci&#243;n globular 57<span class="elsevierStyleHsp" style=""></span>mm&#47;h y prote&#237;na <span class="elsevierStyleSmallCaps">C</span> reactiva 65<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#59; creatinina 1&#44;4<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; urea 126<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; aspartato-aminotransferasa 80<span class="elsevierStyleHsp" style=""></span>U&#47;l&#44; alanino-aminotransferasa 60<span class="elsevierStyleHsp" style=""></span>U&#47;l&#44; bilirrubina total 7&#44;1<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;directa 5&#44;4<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; y examen general de orina con leucocituria&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se estableci&#243; el diagn&#243;stico de EK en funci&#243;n de los criterios de la American Heart Association&#46; La paciente present&#243; en las primeras 24<span class="elsevierStyleHsp" style=""></span>h oliguria&#44; edema e incremento de azoados &#40;creatinina 3<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; urea 194<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#44; el ecocardiograma demostr&#243; aneurisma en la arteria coronaria derecha de 5&#44;8<span class="elsevierStyleHsp" style=""></span>mm y de 8&#44;3<span class="elsevierStyleHsp" style=""></span>mm en la coronaria izquierda&#44; as&#237; como signos de isquemia en pared lateral izquierda del miocardio&#46; Se inici&#243; inmunoglobulina intravenosa a 2<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;dosis y pulsos de metilprednisolona por 3 dosis&#46; Evolucion&#243; favorablemente&#44; a los 2 d&#237;as de tratamiento con creatinina de 1&#44;1<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; bilirrubinas totales 4&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;directa 2&#44;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; y prote&#237;na C reactiva 65<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#46; Se egres&#243; asintom&#225;tica a los 7 d&#237;as de hospitalizaci&#243;n sin alteraciones en los par&#225;metros de laboratorio &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discusi&#243;n</span><p id="par0025" class="elsevierStylePara elsevierViewall">La EK contin&#250;a siendo un reto para el pediatra ya que solo se cuenta con criterios cl&#237;nicos sin tener una prueba espec&#237;fica para el diagn&#243;stico<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; Las formas at&#237;picas e incompletas de la enfermedad se presentan en aproximadamente el 20&#37; de los pacientes&#44; asoci&#225;ndose a un mayor riesgo para desarrollar aneurismas coronarios y un peor pron&#243;stico<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&#46; Los s&#237;ntomas gastrointestinales no pertenecen a los criterios cl&#225;sicos&#44; siendo la colestasis y la elevaci&#243;n de transaminasas&#44; ocasionalmente reportadas<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&#46; La manifestaci&#243;n urinaria m&#225;s frecuente es la piuria est&#233;ril&#44; aunque se ha reportado da&#241;o renal agudo tanto de etiolog&#237;a pre-renal como intr&#237;nseca<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&#44; en el caso de nuestro paciente consideramos la etiolog&#237;a como una nefritis intersticial&#44; aunque no contamos con biopsia renal&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Hasta el momento actual no se encuentran en la literatura casos reportados que asocien colestasis y lesi&#243;n renal aguda en un mismo paciente con EK&#46; Aunque existe una relaci&#243;n significativa entre la lesi&#243;n renal aguda&#44; la edad y los niveles de transaminasas<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusiones</span><p id="par0035" class="elsevierStylePara elsevierViewall">En todo paciente con s&#237;ndrome febril&#44; colestasis y da&#241;o renal agudo&#44; la EK debe considerarse como diagn&#243;stico diferencial&#46; Es necesario realizar m&#225;s estudios para conocer las implicaciones cl&#237;nicas de esta asociaci&#243;n como la falta de respuesta a la inmunoglobulina y un peor pron&#243;stico&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicto de intereses</span><p id="par0040" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Responsabilidades &#233;ticas</span><p id="par0050" class="elsevierStylePara elsevierViewall">None</p></span></span>"
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          "titulo" => "Conflicto de intereses"
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            1 => "Cholestasis"
            2 => "Kawasaki disease"
            3 => "Jaundice"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La enfermedad de Kawasaki &#40;EK&#41; es una vasculitis sist&#233;mica frecuente en ni&#241;os menores de 5 a&#241;os&#44; involucra arterias coronarias y otros vasos de mediano calibre&#44; adem&#225;s existe evidencia de lesi&#243;n inflamatoria y proliferativa de la v&#237;a biliar e infiltraci&#243;n linfocitaria en el intersticio renal&#46; Se presenta el caso de una ni&#241;a de 9 a&#241;os con fiebre de alto grado&#59; desarrollando inyecci&#243;n conjuntival bilateral no purulenta&#44; lengua &#171;aframbuesada&#187;&#44; eritema y descamaci&#243;n en dedos de manos y pies&#44; s&#237;ndrome colest&#225;sico&#44; as&#237; como edema e incremento de azoados&#46; La EK contin&#250;a siendo un reto diagn&#243;stico para el pediatra&#46; En todo paciente con s&#237;ndrome febril&#44; colestasis y da&#241;o renal agudo la EK debe considerarse como diagn&#243;stico diferencial&#44; aunque es necesario realizar m&#225;s estudios para evaluar esta at&#237;pica asociaci&#243;n&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Kawasaki disease &#40;KD&#41; is a systemic vasculitis frequent in children younger than 5 years of age&#46; It involves coronary arteries and other medium-sized vessels&#46; There also exists evidence of inflammatory and proliferative changes affecting the biliary tract and lymphocyte infiltration of the renal interstitial&#46; We describe the case of a 9-year-old girl who developed high-grade fever&#44; bilateral non-purulent conjunctivitis&#44; &#171;strawberry&#187; tongue&#44; desquamation of the fingers and toes&#44; cholestatic syndrome&#44; edema and elevated serum creatinine&#46; KD is a diagnostic challenge for the pediatrician&#46; In every patient with high-grade fever&#44; cholestasis and acute kidney injury&#44; KD should be included in the differential diagnosis&#44; even though more research is necessary to evaluate this atypical association&#46;</p></span>"
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