Purpose:Kawasaki disease (KD) is multisystem vasculitis which accompanies many complications. Incomplete KD frequently leads to delay in diagnosis and treatment. Children with KD may present with a wide variety of gastrointestinal (GI) manifestations. The clinical manifestations include vomiting, diarrhea, abdominal distension, hepatomegaly, paralytic ileus, and hydrops of gall bladder. There is rare report about KD with GI bleeding before the use of aspirin in Korea. We describe a 3-year-old girl who presented with 3 days of fever and cervical lymphadenopathy (right). Conjunctival injection and maculopapular rash in the inguinal area were noted. Vomiting and abdominal pain on the periumblical area were noted. Hematemesis with blood clot was noted on the day of admission. Abdominal sonography revealed that mild hepatomegaly suggesting that liver parenchymal disease including hepatitis, periportal edema and distended gall bladder. Multiple erythema and erosion on the gastric antrum and the duodenal bulb were observed by gastrofiberscopy. Echocardiography revealed mild mitral regurgitation with normal coronary artery. Initial laboratory results were as follows: erythrocyte sedimentation rate(ESR) 71 mm/hr, white blood cell count 11,180/μL, hemoglobin 11.0 g/dL, hematocrit 32.2%, platelet count 318,000/μL, C-reactive protein (CRP) 7.25 mg/dL, N-terminal pro-brain natriuretic peptide (NT pro-BNP) 848 pg/mL. aspartate aminotransferase (AST) 629 IU/L, alanine aminotransferase (ALT) 668 IU/L, total bilirubin 3.3 mg/dL, direct bilirubin 0.3 mg/dL. Occult blood was revealed by stool examination. Fever subsided after the 2nd intravenous immunoglobulin (IVIG) 2g/kg. Proton pump inhibitor (lanston) was administrated due to GI erosion with GI bleeding. GI bleeding completely stopped. Low dose aspirin was started after improvement of gastric and duodenal bulb erosion. Follow up abdominal sonography revealed that improved hepatomegaly, periportal edema, and GB wall thickening. Follow up SGPT, SGPT, bilirubin, CRP, ESR and NT pro-BNP were normal after IVIG treatment. Conclusion: This is a very rare case report of KD in which there was GI bleeding before the use of aspirin in KD. It is very important to monitor GI complications including bleeding in KD.