Initial manifestations of incomplete or atypical Kawasaki disease A case series report.

Abstract

Introduction: Kawasaki disease (KD) is a multisystemic vasculitis that affects small and medium-sized vessels. It is considered the leading cause of acquired heart disease. Its presence at ages less than nine months or after five years is rare. Cases of incomplete or atypical KD may present symptoms of an infectious entity or unusual findings during a disease, making early detection difficult and causing growth retardation and increased risk of cardiac involvement.

Case series: Six clinical cases with a diagnosis of incomplete EK were presented at Dr. Roberto Gilbert Children's Hospital between January 2017 and April 2019; 83.4% were men, 66.8% were under one year of age, and the reason for consultation was fever > 5 days in all cases and rash in 66.6%. On admission, three patients (50%) met 1 of the five diagnostic criteria. Leukocytosis >16,000 u/µl was present in all cases; C-reactive protein (CRP) >15 mg/l was positive in 66.6%, and platelets less than 450 x mm3 in 66.6%. The associated manifestations were aseptic meningitis (33.4%), vesicular hydrops (16.6%), acute abdomen (16.6%), pneumonia (16.6%), and hip synovitis (16.6%).

Conclusions: It can be concluded that the cases described exemplify the variety of incomplete or atypical forms of presentation since the similarities with other infectious processes due to the initial clinical manifestations made diagnosis difficult, which delayed the start of a specific therapy.