A diagnostic challenge in Kawasaki disease: a case report

Kawasaki disease (KD) is characterised by high fever lasting more than 5 days, conjunctivitis, oedema of hands or feet, erythema of the palms and soles, polymorphic rash, cervical lymphadenopathy and alteration of oral mucosa and lips. It is most frequently seen in children between the ages of 6 months and 5 years. The diagnosis of KD remains challenging, primarily due to its incomplete presentation. In this report, we present a 3.5-month-old patient who has persistent fever and bilateral nonpurulent conjunctivitis and high acute phase reactants, diagnosed with incomplete KD and coronary aneurysm. The patient was given intravenous immunoglobulin (IVIG) at 2 g/kg with oral aspirin at 80 mg/kg/d. On follow-up 48 hours later, marked clinical improvement was observed. Monthly cardiac evaluations were performed. Echocardiogram in the 3rd month of treatment showed the internal dimension of the proximal section of the left main coronary artery measuring 3 mm (Z-score = 3.8) and the aneurysm regressed. Even if cases with prolonged fever do not meet the diagnostic criteria for KD, they should be considered as atypical KD and IVIG should be considered.