Asymptomatic Kawasaki Disease in a 3-Month-Old Infant

Abstract

Kawasaki disease (KD) is the leading cause of acquired heart disease in children in the United States. It is a systemic vasculitis characterized by diffuse inflammation of medium and small blood vessels. If untreated it can lead to myocardial infarction, ischemic heart disease, or sudden death. Early recognition and treatment decrease the incidence of coronary consequences, resulting in improved clinical outcomes. Incomplete KD is much less likely to fulfill major clinical diagnostic criteria. Infants <12 months of age are more likely to have an incomplete presentation, and children <6 months of age are more likely to develop cardiac complications. We present a case of a 3-month-old, previously healthy white boy who was noted to have a new transient cardiac murmur during a routine health assessment. He was completely asymptomatic, and physical examination was otherwise within normal limits. An echocardiogram was performed and showed abnormal dilation of several coronary arteries, consistent with the coronary ectasia associated with KD. Laboratory evaluation was significant for values suggestive of systemic inflammation. Based on these results, a presumed diagnosis of incomplete KD was made and treatment administered. Close surveillance was undertaken, and serial laboratory studies and imaging showed gradual resolution of inflammatory markers and cardiac ectasia. This unique case of incomplete KD without any of the physical signs normally associated with the disease emphasizes the spectrum of presentation and the possibility of missing a diagnosis of incomplete disease, reinforcing the need to remain vigilant.

Kawasaki Disease Presenting as Hydrops of the Gallbladder

“…3 However, Kawasaki disease without fever is well reported. [11][12][13][14] In contrast to our patient, these afebrile cases occurred in younger infants (younger than 13 months). Additionally, there have been reports of coronary sequelae and biomarkers consistent with Kawasaki disease, without the patient meeting the AHA criteria.…”

Risk of coronary artery lesions in young infants with Kawasaki disease: need for a new diagnostic method

“…Most (79%) of the patients had no principal clinical features at the onset of fever, while five patients (21%) had no features other than fever until the 5th day of illness. Our results indicate that it is difficult to diagnose incomplete KD in young infants younger than 3 months of age, because of presentation with unfulfilled criteria …”

“…In some cases, KD has been suspected in young infants without fever . Our study revealed that sterile pyuria, cerebrospinal fluid pleocytosis, and seizures associated with KD could potentially lead to misdiagnosis and treatment delay .…”

Case of Incomplete Kawasaki Disease with No Symptoms Except Fever Causing the Development of Coronary Aneurysm

“…3) The clinical importance is further buttressed by the fact that coronary artery dilation can develop even in a patient with iKD presenting with no principal symptoms. 11) Although the national KD database in Japan revealed that coronary artery aneurysm occurred in 25% of iKD cases satisfying only one of the six principal symptoms, 4) to the best of our knowledge, detailed reports 12,13) of such cases are limited. In contrast to those case reports, 12,13) our report provided echocardiographic and angiographic evidence of the coronary artery aneurysms.…”