Kawasaki Disease In A 3-Month Boy

Background: Kawasaki Disease often develops between the age of 6 months and 5 years. It is the most common cause of acquired heart disease in children of developed countries. In infants of less than one year old, the disease appears frequently with atypical symptoms, while if it appears after 6 months, the infants have a greater chance to develop cardiovascular complications.

Objective: Herein, we report a case of a 3,5-month-old infant with Kawasaki Disease.

Method: A 3,5-month-old infant presented with fever and conjunctivitis. The infant was treated with amoxicillin for pharyngotonsillitis. The infant then developed a maculopapular rash of the trunk which was attributed to an allergic reaction and antihistaminic treatment was administered. Due to the persistence of symptoms for 5 days, the patient presented to the hospital. The clinical examination showed fever, rush of the trunk, conjunctivitis and cheilitis. The lab tests presented leukocytosis, thrombocytosis, and high inflammatory markers. The infant was treated with antibiotics without clinical improvement, the fever continued and irritability, anxiety and feeding disorders were added to the symptoms.

Result: The prolonged fever in combination with the symptoms led to the diagnosis of Kawasaki disease, as the cardiac ultrasound showed multiple and large diameter aneurysms of the coronary arteries. The infant was treated on day 8 from the beginning of the symptoms, with IV gamma globulin, aspirin and LMWH. The follow-up ultrasounds and the development of the child was normal.

Conclusions: Kawasaki disease is rare in infants under 6-month-old, but it has to be part of the differential diagnosis of prolonged fever even without the typical symptoms, mainly due to the increased incidence of cardiovascular complications in this age range.