The approach to incomplete Kawasaki disease in infants

Abstract

The manifestations of Kawasaki disease in infants are often subtle and many times infants with this condition do not meet full diagnostic criteria. The approach to incomplete Kawasaki disease remains a challenge for physicians because clinical features may be mistaken for symptoms of other conditions. Young infants are at an extremely high risk of developing coronary arterial abnormalities compared to older children, probably due to the delay in diagnosis and the fact that only a small number receive intravenous immunoglobulin (IVIG) during the first 10 days of illness. We present a 5-month-old boy treated at our pediatric intensive care unit. The boy presented with fever lasting for more than five days, unresponsive to antibiotic therapy, changes in extremities (erythema, edema and desquamation), polymorphous rash, changes in the lips and oral cavity, seizures, irritability, pyuria, anemia, leukocytosis and raised titer of acute phase reactants. The presence of rash was initially mistaken for a reaction to antibiotics administered for a presumed urinary tract infection. All bacterial cultures and serologic tests were negative. Echocardiography showed no abnormality, but according to the criteria for incomplete Kawasaki disease published by the American Academy of Pediatrics and American Heart Association, we decided to treat the child with IVIG. With this report, we would like to highlight the importance of a high degree of clinical suspicion of Kawasaki disease in infants in whom the presentation is often incomplete, while prompt IVIG therapy is crucial to avoid serious cardiac complications.