Kawasaki Disease

A 10-month-old, previously healthy female infant presented with a high-grade fever for 2 days. There were no neurological, respiratory, gastrointestinal, genitourinary, or musculoskeletal symptoms and no focus of infection on clinical examination. Urine automated microscopy report revealed 10–12 pus cells/HPF. Hence urine culture was sent, and she was started on oral antibiotics for possible urinary tract infection (UTI). On review after 48 h, high fever persisted, and she was also becoming irritable but there were no signs of meningitis. Her complete blood count was normal, C-reactive protein (CRP) was 1.3 (<0.8) mg/dL, and erythrocyte sedimentation rate (ESR) was 40(0–15) mm/first hour. Urine culture showed no growth. She was hospitalized with a diagnosis of possible sepsis, blood culture was sent, and she was started on intravenous (IV) ceftriaxone. Even after 48 h of IV antibiotics, fever and irritability persisted. Clinical examination did not reveal any focus of infection. Vital signs and perfusion were normal. Blood and urine cultures did not grow any organism. Abdominal ultrasonography and chest radiograph were normal. Blood tests were repeated (day 6 of illness), and they showed an ESR of 80 mm/first hour and a serum CRP level of 5 mg/dL. Her peripheral leukocyte and thrombocyte counts were 15,200 and 680,000/mL, respectively. Her echocardiography revealed dilatation of the coronary arteries (CAs). The Z-scores of the left and right main CA were +2.13 and +4.13, respectively. Thus, a diagnosis of incomplete Kawasaki disease (KD) was made in the child. She was treated with intravenous immunoglobulin (IVIG) (2 g/kg) and high-dosage aspirin (30 mg/kg per day divided into 4 doses/day). Her fever regressed, and she was discharged after 5 days on low-dose aspirin (3mg/kg per day). A gradual regression was observed in the coronary blood vessels on follow-up, and the echocardiographic findings normalized after 2 months.