A Case of Sudden Infant Death Due to Incomplete Kawasaki Disease

Area of Science:

• Pediatrics
• Cardiology
• Forensic Pathology

Background:

• Kawasaki disease (KD) is a self-limiting vasculitis, but can cause severe cardiac complications including sudden death.
• Diagnosis typically relies on clinical criteria, but incomplete KD cases may not meet these criteria.
• Incomplete KD poses a similar risk of sudden cardiac death as classic KD.

Observation:

• A 5-month-old infant presented with fever and BCG vaccination site suppuration, initially improving but later experiencing sudden death.
• Medico-legal autopsy revealed myocarditis, coronaritis, myocardial degeneration, and coronary artery thrombi.
• Findings suggested myocardial infarction secondary to embolic events in the coronary arteries.

Findings:

• The autopsy findings in this infant case are consistent with cardiac pathology from undiagnosed incomplete Kawasaki disease.
• Platelet-aggregated emboli in coronary arteries were identified as the likely cause of fatal myocardial infarction.
• The case underscores the potential for severe cardiac sequelae in incomplete KD.

Implications:

• Forensic pathologists should consider incomplete Kawasaki disease as a potential cause of sudden unexpected infant death.
• Early recognition and management of incomplete KD are crucial to prevent fatal cardiac events.
• This case highlights the need for heightened awareness of cardiac risks in infants presenting with fever and inflammation, even if they don't meet full KD criteria.