The Turkish Journal of Pediatrics
2013 , Vol 55 , Num 5
Incomplete Kawasaki disease in an infant presenting with only prolonged fever
Divisions of 1Pediatric Infectious Diseases, and 3Pediatric Cardiology, 2Department of Pediatrics, Ankara University Faculty
of Medicine, Ankara, Turkey. E-mail: doktorhalil@gmail.com
A 2.5-month-old boy admitted to our hospital with irritability, poor feeding
and fever of 12 hours’ duration. On physical examination, he was febrile
and extremely irritable. Initial whole blood count revealed a hemoglobin
level of 10.1 g/dl, white blood count of 17,800/mm3 and platelet count of
454,000/mm3. Erythrocyte sedimentation rate was 80 mm/h and C-reactive
protein was 3.96 mg/dl. Biochemical examinations of serum, urinalysis, chest
X-ray, and analysis of cerebrospinal fluid (CSF) were normal. He was started
on intravenous ampicillin and ceftriaxone empirically for provisional occult
bacteremia. His blood, urine and CSF cultures were negative. On the 7th
day of the treatment, there were no additional symptoms or findings other
than fever. Echocardiography revealed aneurysms in both the left and right
coronary arteries. Intravenous immunoglobulin (IVIG) and per oral aspirin
were administered, and the fever resolved after IVIG infusion. Two years
later, the echocardiography showed disappearing of the saccular aneurysm
on the right coronary artery, but the dilatation of the left coronary artery
was persisting. In conclusion, incomplete Kawasaki disease should always
be included in the differential diagnosis of an infant with persistent fever,
especially one younger than three months of age, when the conventional
work-up fails to reveal the underlying cause.
Keywords :
child, incomplete Kawasaki disease, Kawasaki disease, prolonged fever.