[A 9-week-old boy with fever and diarrhoea]

Area of Science:

• Pediatrics
• Immunology
• Cardiology

Background:

• Kawasaki disease is an acute febrile vasculitis primarily affecting children aged 3 months to 12 years.
• Neonatal Kawasaki disease is rare, accounting for only 2% of cases, and often presents atypically.
• Early diagnosis and treatment are crucial to prevent coronary artery aneurysms and potential fatal outcomes.

Observation:

• A 9-week-old boy presented with prolonged fever, diarrhea, rhinitis, and elevated C-reactive protein (CRP).
• Stool examination identified Enterovirus, initially suggesting viral gastroenteritis.
• Echocardiography revealed dilated coronary arteries and pericardial fluid, despite the patient meeting only three criteria for classical Kawasaki disease.

Findings:

• The neonate was diagnosed with incomplete Kawasaki disease due to atypical presentation.
• Elevated CRP levels persisted throughout the initial days of illness.
• Dilated coronary arteries and pericardial effusion were significant echocardiographic findings.

Implications:

• This case underscores the importance of considering Kawasaki disease in neonates with unexplained prolonged fever.
• Atypical presentations in neonates necessitate a high index of suspicion for this immunologic vasculitis.
• Prompt recognition and management of neonatal Kawasaki disease can mitigate the risk of severe cardiac complications.