Kawasaki at the Extremes of Age: Thinking Outside the Box

Pediatr Emerg Care. 2019 Dec;35(12):e229-e231. doi: 10.1097/PEC.0000000000001991.

Abstract

Kawasaki disease is an acute vasculitis syndrome that typically occurs in children aged 1 to 4 years. Because there is no specific diagnostic test for Kawasaki disease, the diagnosis is made clinically based on specific characteristic signs and symptoms. Cases in which patients fall outside of the typical age range are uncommon and often challenging to diagnose because they have atypical presentations. This is especially true in infants, who rarely meet all the clinical criteria required for diagnosis. Patients at the extremes of ages often have a delayed diagnosis, which can lead to worse cardiac outcomes. We describe the cases of a young infant and an older adolescent who present with Kawasaki disease. These cases illustrate the challenge of diagnosing Kawasaki disease in patients beyond the typical age range. Both patients were return visits to the emergency department after inpatient stays. When fever persists longer than 5 days, clinicians must have a high index of suspicion for Kawasaki disease in all pediatric age groups to prevent treatment delay and disease sequelae.

Publication types

  • Case Reports

MeSH terms

  • Administration, Intravenous
  • Adolescent
  • Aneurysm / pathology
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Arthralgia / etiology
  • Aspirin / administration & dosage
  • Aspirin / therapeutic use
  • Coronary Vessel Anomalies / diagnostic imaging
  • Coronary Vessel Anomalies / pathology
  • Echocardiography / methods
  • Emergency Service, Hospital
  • Exanthema / diagnosis
  • Exanthema / etiology*
  • Female
  • Fever / diagnosis
  • Fever / etiology*
  • Fistula / pathology
  • Humans
  • Immunoglobulins / administration & dosage
  • Immunoglobulins / therapeutic use
  • Immunologic Factors / administration & dosage
  • Immunologic Factors / therapeutic use
  • Infant
  • Male
  • Mucocutaneous Lymph Node Syndrome / diagnostic imaging*
  • Mucocutaneous Lymph Node Syndrome / drug therapy
  • Mucocutaneous Lymph Node Syndrome / pathology*

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Immunoglobulins
  • Immunologic Factors
  • Aspirin