Incomplete Kawasaki disease associated with acute icteric hepatitis and Torque teno virus infection: a case report and literature review

Sep 30, 2026

Kawasaki disease (KD) is an acute, self-limiting vasculitis in young children; however, acute jaundice and liver dysfunction are atypical findings. A 17-month-old boy presented with persistent fever, jaundice, and elevated liver enzymes, without classic mucocutaneous KD signs at onset. As symptoms evolved, dorsal foot edema, erythematous lips, and cervical lymphadenopathy emerged. Echocardiography on day 9 showed left coronary artery dilation, and peripheral blood sequencing detected Torque teno virus type 28. Treatment with intravenous immunoglobulin, methylprednisolone, and hepatoprotective agents led to clinical and laboratory recovery.

LanguageEnglish

CategoryHealthcare

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Pages9

Reading Time23 min

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Abstract

Introduction

Case presentation

Conclusions

Background

Liao et al. BMC Pediatrics (2026) 26:14 BMC Pediatrics [https://doi.org/10.1186/s12887-025-06214-2](https://doi.org/10.1186/s12887-025-06214-2) CASE REPORT Open Access Incomplete Kawasaki disease associated with acute icteric hepatitis and Torque teno virus infection: a case report and literature review Yun Liao2, Yunwei Liu2, Shangge Xu3, Jinghua Yang3,4* andYiting Chen1,3* Abstract Introduction : Kawasaki disease (KD) is an acute, self-limiting vasculitis that primarily affects children under five years of age. Its classic clinical features include prolonged fever, bilateral conjunctival injection, changes in the lips and oral cavity, cervical lymphadenopathy, rash, and extremity changes. Acute jaundice and liver dysfunction are atypical manifestations of KD. Cases in which jaundice is the initial presenting symptom—especially when accompanied by Torque Teno Virus (TTV) infection—are rarely reported. Case presentation : We describe a 17-month-old boy diagnosed with incomplete Kawasaki disease (IKD), who initially presented with persistent fever, jaundice, and elevated liver enzymes. At disease onset, characteristic mucocutaneous signs of KD were absent. As the illness progressed, the patient developed dorsal foot edema, erythematous lips, and cervical lymphadenopathy. On the ninth day of illness, echocardiography revealed dilation of the left coronary artery, confirming a retrospective diagnosis of IKD. Additionally, high-throughput sequencing of peripheral blood identified TTV type 28. The patient was treated with intravenous immunoglobulin, methylprednisolone, and hepatoprotective agents. Following treatment, his fever resolved, jaundice subsided, liver function normalized, and coronary artery dimensions gradually returned to within the normal range. Conclusions This case highlights an atypical presentation of IKD, characterized by early-onset jaundice and later development of coronary artery dilation, in a patient also infected with TTV. To our knowledge, this is the first reported case of IKD associated with acute icteric hepatitis and TTV infection. This case may inform clinical evaluation in similar presentations and contribute to future research on the etiology of KD. Keywords Kawasaki disease, Acute icteric hepatitis, Torque teno virus, Jaundice, Case report *Correspondence: Jinghua Yang [doumiaomama@126.com](doumiaomama@126.com)[ ](doumiaomama@126.com)Yiting Chen [doctorchenyiting@126.com](doctorchenyiting@126.com) 1Guangdong Provincial Key Laboratory of Research and Development in Traditional Chinese Medicine, Guangzhou 510095, China 2The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China 3Department of Pediatrics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China 4Youjia Xu’s Renowned Expert Inheritance Studio, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China © The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://

FAQs

Why is the presentation described as atypical for Kawasaki disease?

The case involves early-onset jaundice and liver dysfunction, which are atypical manifestations of Kawasaki disease. Classic mucocutaneous signs were absent at initial presentation.

What role did echocardiography and sequencing play in the diagnosis?

Echocardiography on illness day 9 revealed dilation of the left coronary artery, supporting a retrospective diagnosis of incomplete Kawasaki disease. High-throughput sequencing identified Torque teno virus type 28 in peripheral blood.

How was the patient treated and what was the outcome?

The patient received intravenous immunoglobulin, methylprednisolone, and hepatoprotective agents. After treatment, fever resolved, jaundice subsided, liver function normalized, and coronary artery dimensions gradually returned within normal range.

Sep 30, 2026

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