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Incomplete Kawasaki disease in the 2-month-old infant: A case report
Wei Ma1, Juan Sun, Huaili Wang
1Department of Pediatric Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Insights
Diagnosing incomplete Kawasaki disease (KD) is challenging in infants under six months. Early recognition of fever and neurological symptoms is crucial for timely treatment and preventing coronary artery issues.
Area of Science:
- Pediatrics
- Rheumatology
- Infectious Diseases
Background:
- Kawasaki disease (KD) diagnosis is challenging, particularly in infants outside the typical age range (6 months to 5 years).
- Incomplete KD (IKD) and atypical presentations further complicate early diagnosis, leading to potential delays.
- Infants <6 months present unique diagnostic challenges due to atypical symptoms.
Observation:
- A 2-month-20-day-old infant presented with fever, seizure, poor feeding, and foot swelling.
- Initial symptoms lacked classic signs of KD, prompting consideration of IKD.
- The appearance of cracked lips and subsequent periungual desquamation confirmed the IKD diagnosis.
Findings:
- Treatment with intravenous immunoglobulins, aspirin, and dipyridamole led to normalization of inflammatory markers (temperature, CRP, ESR).
- No coronary artery lesions were observed post-treatment, indicating successful early intervention.
- Periungual desquamation served as a key diagnostic indicator in this atypical case.
Implications:
- This case underscores the importance of considering IKD in febrile infants with neurological symptoms, even without principal KD findings.
- Early diagnosis and treatment in infants <6 months are critical to prevent cardiac complications associated with Kawasaki disease.
- Clinicians should maintain a high index of suspicion for IKD in young infants presenting with non-specific symptoms.
Rationale:
The diagnosis of Kawasaki disease (KD) is difficult and is often delayed for children whose age falls outside the typical age range of 6 months to 5 years, especially for those with incomplete KD (IKD) or atypical features.
Patient Concerns:
A 2-month-20-day-old girl presented to our hospital with a chief complaint of intermittent fever for 1 day and 1 episode of seizure, with poor feeding and swelling of feet.
Diagnosis:
Until the appearance of red cracked lips, a diagnosis of IKD was considered. A rise in periungual desquamation of the hands confirmed the diagnosis.
Interventions:
Intravenous immunoglobulins were administered and aspirin and dipyridamole were used orally.
Outcome:
The temperature, C-reactive protein, and erythrocyte sedimentation rate returned to normal level and there was no coronary artery lesion.
Lessons:
This case highlights that the diagnosis of IKD should be considered in children whose primary presentation is fever and neurologic features, lacking principal clinical findings, particularly those <6 months of age.
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