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Published on: September 20, 2018
Incomplete Kawasaki Disease Presenting as Orbital Cellulitis in a Child
Mohammed Rabbani1, K Jagadish Kumar1, V G Manjunath1
1Department of Pediatrics, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India.
Insights
Periorbital cellulitis can be an early sign of incomplete Kawasaki disease (KD) in children. Prompt recognition and treatment with intravenous immunoglobulin (IVIG) are crucial to prevent serious complications.
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.
Purpose:
To describe a case of periorbital cellulitis as the manifestation of Kawasaki disease (KD).
Methods:
A single case report.
Results:
A 15-month-old child presented with fever and swelling around the eyes, initially diagnosed as orbital cellulitis. On examination, the child exhibited bilateral orbital swelling with conjunctival congestion, strawberry tongue, cracked lips, significant bilateral cervical lymphadenopathy, and perianal excoriation. Although many clinical features were compatible with KD, the diagnostic criteria for KD were not fully met. Despite 48 h of antibiotic therapy, the child continued to experience high-grade fever spikes. Consequently, the diagnosis was reviewed and reclassified as incomplete KD. The child was then administered intravenous immunoglobulin (IVIG) at a dosage of 2 g/kg over 10 h. Within 48 h of IVIG administration, the fever subsided and the periorbital swelling decreased.
Conclusions:
The diagnosis of incomplete KD requires a high index of suspicion as the delay in diagnosis may lead to coronary involvement. Any young child with orbital cellulitis unresponsive to antibiotic therapy should be investigated for underlying KD.
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Etiology
Three primary contributing factors have been identified.