SHM Converge Scientific Abstract ePoster Gallery-Babies Don't Read Textbooks: Difficulty of Kd Diagnosis in Infants

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This case report highlights how difficult Kawasaki disease (KD) can be to diagnose in very young infants. A 57-day-old full-term girl presented with one day of fever, diffuse rash, and congestion, and was initially thought to have a viral exanthem/erythema multiforme. She was discharged but returned the next day with recurrent fever, worsening rash, irritability, and mild swelling of the hands and feet.<br /><br />Laboratory studies showed significant inflammation, but infectious workup was negative. Because KD was considered, an echocardiogram was obtained and showed mildly enlarged coronary dimensions, with a right coronary artery Z-score near 2 standard deviations above the mean. Given the persistent fever, rash, and inflammatory findings, clinicians made a presumptive diagnosis of Kawasaki disease and treated her with IVIG. She improved rapidly, and a repeat echocardiogram 48 hours later showed normalization of coronary artery measurements.<br /><br />The report emphasizes that KD in infants younger than 6 months is often incomplete or subtle, making it easy to mistake for a viral illness. Despite this, these infants are at higher risk of early coronary artery injury, even within the first few days of fever. The authors stress the importance of maintaining a high index of suspicion when a young infant has unexplained fever, rash, and inflammation, even without classic KD signs such as conjunctivitis, oral changes, or lymphadenopathy. They note that American Heart Association guidelines support obtaining an echocardiogram in such cases. Early recognition and treatment are critical to prevent coronary complications and improve outcomes.

Asset Subtitle

Gina Allyn

Meta Tag

Author List Aarti Patel, Gina Allyn, Jane C. Burns, Samantha Fine, Tatyana G. Mills

Category Clinical Vignettes

Concept Kawasaki Disease

Concept Coronary Artery Involvement

Concept Intravenous Immunoglobulin

Concept Infant

Concept Fever

Distinguished Non-Finalist

Presenter Organization UC San Diego / Rady Children's Hospital

Presenting Author Gina Allyn

Track Pediatric

Keywords

Kawasaki disease

infant fever

coronary artery dilation

IVIG treatment

rash

echocardiogram

inflammation

young infant

viral exanthem

early diagnosis

Kawasaki Disease

Coronary Artery Involvement

Intravenous Immunoglobulin

Infant

Fever