Volume 4, Issue 3

Introduction. Infants younger than 12 months with Kawasaki disease often present with incomplete clinical features and are at the highest risk of coronary artery aneurysms, particularly when diagnosis and treatment are delayed. Case presentation. A previously healthy 7-month-old boy presented on illness day 9 with persistent fever, irritability and a transient rash despite oral antibiotics for presumed otitis media. Examination showed bilateral nonexudative conjunctival injection and erythema at his BCG vaccination site, without other principal features. Laboratory tests revealed a C-reactive protein of 186 mg/L, leukocytosis, anemia, hypoalbuminemia, elevated alanine aminotransferase and sterile pyuria. Echocardiography showed a giant aneurysm of the proximal left anterior descending artery (5.4 mm, Z-score +11.2) and a medium aneurysm of the right coronary artery. He received intravenous immunoglobulin, aspirin and adjunctive corticosteroids, followed by infliximab for recrudescent fever, and low-dose aspirin with enoxaparin for thromboprophylaxis. The left anterior descending aneurysm reached a maximum Z-score of +14.8 at 3 weeks, and no thrombus or ischemia had developed by 3 months. Conclusion. Incomplete Kawasaki disease should be considered in any infant with prolonged unexplained fever, even when few clinical criteria are present. Early use of supplementary laboratory criteria and echocardiography can shorten the delay to treatment.