Rural Presentation of Kawasaki Disease with Leukopenia and Transaminitis

Kawasaki disease (KD) is an acute, self-limited vasculitis that primarily affects young children, and early treatment is essential to prevent coronary artery complications. Diagnosis is clinical and can be challenging in children who present atypically or receive initial evaluation in resource-limited settings. We report a case of KD in a 6-year-old girl who presented to a rural clinic with six days of fever, a progressive polymorphous rash, bilateral conjunctivitis, and mucocutaneous changes. Her evaluation showed leukopenia, marked transaminitis, elevated inflammatory markers, and an extensive negative infectious workup. These findings, along with her older age and a pruritic rash, complicated initial recognition and broadened the differential to include viral exanthems and systemic infections. KD was suspected based on her clinical course, and she was promptly transferred to a tertiary pediatric center, where she met four of the five diagnostic criteria. She received intravenous immunoglobulin and high-dose aspirin, resulting in rapid improvement. Echocardiography showed no coronary involvement. This case reinforces the importance of maintaining suspicion for KD in children with prolonged fever and mucocutaneous findings, even when laboratory abnormalities are atypical. It also highlights the value of early consultation, efficient transfer pathways, and collaboration between rural and tertiary facilities to ensure timely treatment and reduce the risk of cardiac complications.