Incomplete Kawasaki Disease Presenting as Orbital Cellulitis in a Child

Area of Science:

• Pediatrics
• Infectious Diseases
• Rheumatology

Background:

• Kawasaki disease (KD) is a vasculitis affecting medium-sized arteries, primarily in young children.
• Early diagnosis and treatment of KD are essential to prevent coronary artery aneurysms.

Observation:

• A 15-month-old child presented with fever and periorbital swelling, initially diagnosed as orbital cellulitis.
• Clinical findings included bilateral orbital swelling, conjunctival congestion, strawberry tongue, cracked lips, cervical lymphadenopathy, and perianal excoriation.
• The patient did not meet full criteria for classic KD but responded to treatment for incomplete KD.

Findings:

• The child's symptoms, including persistent fever despite antibiotics, suggested incomplete Kawasaki disease.
• Treatment with intravenous immunoglobulin (IVIG) led to rapid resolution of fever and periorbital swelling.
• This case highlights periorbital cellulitis as a potential presenting sign of incomplete KD.

Implications:

• A high index of suspicion for incomplete KD is necessary in young children with orbital cellulitis unresponsive to antibiotics.
• Delayed diagnosis of incomplete KD can increase the risk of coronary artery abnormalities.
• Early investigation and management of suspected incomplete KD are critical for favorable outcomes.