Patterned Clues in an Infant With Annular Rash and Seizures Revealing Kawasaki Disease

Area of Science:

• Pediatric Rheumatology
• Infectious Diseases
• Neurology

Background:

• Kawasaki disease (KD) is a leading cause of acquired heart disease in children, characterized by systemic vasculitis.
• Atypical presentations of KD, particularly in young infants, pose diagnostic challenges.
• Neurological complications and unusual rash morphologies are infrequently reported but can occur.

Purpose of the Study:

• To highlight the diagnostic difficulties posed by rare, atypical clinical features in Kawasaki disease.
• To present a case of Kawasaki disease with unusual annular/targetoid rash and neurological manifestations.
• To emphasize the importance of considering KD in the differential diagnosis of febrile infants with atypical symptoms.

Main Methods:

• Case report detailing the clinical presentation, diagnostic workup, and management of an infant with Kawasaki disease.
• Review of literature concerning atypical Kawasaki disease presentations, including neurological involvement and unusual dermatological findings.

Main Results:

• The patient exhibited rare annular/targetoid rashes and neurological symptoms (seizures, aseptic meningitis), mimicking meningoencephalitis and infectious eruptions.
• Diagnostic uncertainty arose due to the constellation of atypical signs, delaying definitive diagnosis.
• Successful treatment of Kawasaki disease was achieved upon recognition of the underlying vasculitis.

Conclusions:

• Kawasaki disease can manifest with highly variable and atypical features, including uncommon rashes and neurological complications.
• Clinicians must maintain a high index of suspicion for Kawasaki disease in infants presenting with fever and unusual symptoms, even when mimicking other conditions.
• Prompt diagnosis and initiation of appropriate therapy are essential to prevent coronary artery abnormalities in Kawasaki disease.