An atypical presentation of Kawasaki syndrome in an infant

Kawasaki syndrome (KS) is a vasculitis of childhood, the etiology of which is unknown. Diagnosis is based on the Center for Disease Control (CDC) criteria in which skin and mucous membrane findings play a key role. Coronary artery involvement can be fatal. Prompt diagnosis and initiation of therapy can reduce the risk of cardiac complication. Autopsy findings of patients with KS who did not fit CDC criteria for symptoms have been reported. Infants, in particular, may have an atypical clinical course resulting in delayed diagnosis and initiation of treatment. This case presents an infant with fever and an atypical rash who did not fit diagnostic criteria. Differential diagnosis of infants with prolonged fevers and rash, who do not fit into other diagnostic categories, should include KS and an appropriate cardiac examination including consideration of an echocardiogram.