Title: Kawasaki Disease: A Case Report in a Patient
Author:
Varun Dwivedi, MEDS20-2A
Abstract:
Kawasaki disease (KD) is an acute febrile illness primarily affecting children under the age of
5 years. It is characterized by systemic inflammation of medium-sized blood vessels and
presents with a constellation of clinical manifestations. I report a case of KD in a 3-year-old
male child who presented with classic symptoms and was successfully treated with
intravenous immunoglobulin (IVIG) therapy. This case underscores the importance of early
recognition and management of KD to prevent potential complications, particularly
coronary artery abnormalities.
Keywords: Kawasaki disease, pediatric, intravenous immunoglobulin, coronary artery
abnormalities
Introduction:
Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is an acute
self-limiting vasculitis predominantly affecting children under the age of 5 years. It is
characterized by fever, mucocutaneous involvement, lymphadenopathy, and systemic
inflammation of medium-sized blood vessels. KD can lead to coronary artery abnormalities,
including coronary artery aneurysms, if not promptly recognized and treated. Here, we
present a case of KD in a 3-year-old male child, highlighting the clinical features, diagnostic
workup, and management strategies.
Case Presentation:
A 3-year-old male child presented to the pediatric outpatient clinic with a five-day history of
fever (up to 39°C) and irritability. The parents reported that the fever was not responsive to
antipyretics. On further questioning, the child had also developed a rash on his trunk and
extremities, along with redness and crusting of the lips. There was no history of cough,
rhinorrhea, vomiting, diarrhea, or recent travel.
Physical examination revealed a febrile child with bilateral non-exudative conjunctivitis, red
lips with fissuring, and a diffuse erythematous rash on the trunk and extremities. Cervical
lymphadenopathy (approximately 1 cm in diameter) was noted. Cardiac auscultation was
unremarkable, with no murmurs appreciated. The rest of the systemic examination was
within normal limits.
Investigations:
Laboratory investigations revealed leukocytosis (white blood cell count: 16,000/mm^3,
normal range: 5,000-15,000/mm^3) with neutrophil predominance, elevated acute phase
reactants (C-reactive protein: 5 mg/dL, normal range: < 0.5 mg/dL; erythrocyte
sedimentation rate: 50 mm/hr, normal range: 0-20 mm/hr), and mild thrombocytosis
(platelet count: 450,000/mm^3, normal range: 150,000-450,000/mm^3). Complete
metabolic panel, blood culture, and urinalysis were normal.
Echocardiography showed dilatation of the left and right coronary arteries, consistent with
coronary artery ectasia (Z score > 2.5). Based on the clinical presentation and diagnostic
criteria (fever lasting ≥5 days with ≥4 of the following: bilateral conjunctival injection,
changes in the lips and oral cavity, cervical lymphadenopathy, rash, and extremity changes),
a diagnosis of Kawasaki disease was made.
Management:
The patient was promptly started on intravenous immunoglobulin (IVIG) therapy (2 g/kg)
along with high-dose aspirin (80-100 mg/kg/day). Fever subsided within 24 hours of IVIG
infusion. Aspirin therapy was continued at anti-inflammatory doses until the patient
remained afebrile for 48 hours, followed by a tapering regimen. Serial echocardiograms
were performed to monitor coronary artery dimensions.
Outcome:
The child responded well to IVIG therapy, with resolution of fever and improvement in
clinical symptoms. Follow-up echocardiograms at 6 weeks and 6 months revealed
normalization of coronary artery dimensions. The child remained asymptomatic, with no
evidence of coronary artery abnormalities or other complications of KD during subsequent
follow-up visits.
Discussion:
Kawasaki disease is a multisystem vasculitis primarily affecting children, with potential
complications including coronary artery abnormalities. Timely diagnosis and treatment with
IVIG therapy and aspirin are essential to prevent long-term sequelae. Clinicians should
maintain a high index of suspicion for KD in children presenting with prolonged fever and
characteristic clinical features.
Conclusion:
This case emphasizes the importance of early recognition and management of Kawasaki
disease to prevent coronary artery complications. Prompt initiation of IVIG therapy and
close monitoring of coronary artery dimensions are crucial for favorable outcomes in
children with KD. Long-term follow-up is necessary to detect and manage potential late
cardiovascular complications.
IMAGES –
Typical findings in Kawasaki disease
A Bilateral, nonpurulent conjunctivitis
B Stomatitis with bright red lips
C Erythema and edema of the hands
D Erythema and edema of the feet
E Truncal rash
F Cervical lymphadenopathy
G Ultrasound of an enlarged cervical lymph node: increased perfusion
H Desquamation of fingertips
I Deep grooves in the nail (Beau lines)
