A 3-month-old infant with atypical Kawasaki disease

Abstract

We report a 3-month-old girl who presented with high-grade fever for 3 days. Her initial physical examination was normal. Investigation showed abnormal white cells in her urine. She was diagnosed with a urinary tract infection and received an antibiotic for 1 day. After that, she developed a generalised maculopapular rash over her body. An adverse drug reaction from the antibiotic was suspected, and the patient was referred to our hospital. On admission, she still had fever and was irritable. She was diagnosed with sepsis and given another broad-spectrum antibiotic for 2 days. However, her fever still persisted. An additional thorough physical examination showed redness of her BCG inoculation scar. Consequently, a diagnosis of Kawasaki disease (KD) was made. After she received intravenous immunoglobulin, her fever diminished straight away. This case highlights an unusual manifestation of KD in an uncommonly young age group.

Kawasaki disease in siblings and a review of drug treatment

“…Suffice to say, KD is uncommon in the first few months of life. 8 This is especially so for the familial occurrence in siblings of such a young age. Our report is unique in that one sibling had classic KD while the other sibling had incomplete KD.…”

“… 2 Incomplete KD occurs most frequently in young infants (<6 months) and children >9 years of age. 8 Patients with fever for 5 or more days plus 2–3 major clinical features are considered to have incomplete KD. 2 Incomplete KD should not be regarded as mild KD because the risk of coronary artery abnormalities is comparable, if not higher, than classic KD.…”

Incomplete Kawasaki Disease: A Case Report

“…Kawasaki has another important clinical sign usually seen in babies less than a year, reaction at BCG vaccination site but is not included in the classical clinical criteria of KD. 8 Any redness or crust formation on site of inoculation should never be ignored as it can be suggestive of KD and should always be considered as the differential diagnosis of any febrile illness of unknown etiology or vasculitis. 8 American heart association suggests that children with fever not subsiding for 5 days or more, elevated CRP and ESR levels should go for Echocardiographic findings to rule out KD.…”

“…8 Any redness or crust formation on site of inoculation should never be ignored as it can be suggestive of KD and should always be considered as the differential diagnosis of any febrile illness of unknown etiology or vasculitis. 8 American heart association suggests that children with fever not subsiding for 5 days or more, elevated CRP and ESR levels should go for Echocardiographic findings to rule out KD. 9 The management of Kawasaki includes I/V immunoglobulin G and aspirin followed by periodic check up and repeated echocaridography.…”