Bilateral subdural collections--an unusual feature of possible Kawasaki disease

A case of possible Kawasaki disease presenting with bilateral subdural collections is reported. A 6-month-old boy was admitted to hospital following a prolonged partial seizure. He showed signs of worsening encephalopathy and was treated for presumed infective meningoencephalitis. Imaging revealed bilateral subdural collections. Pyrexia and irritability continued despite appropriate antibiotic and antiviral therapy suggesting a vasculitic process. The mucocutaneous signs normally associated with Kawasaki disease were subtle and fleeting in this infant. There was a dramatic clinical response to intravenous immunoglobulin and high dose aspirin. At 2-year follow-up the boy has made a complete recovery with no echocardiographic evidence of coronary artery aneurysm and resolution of subdural collections. Kawasaki disease or other vasculitides should be considered in the differential diagnosis of acute subdural collections in infancy.