SHM Converge Scientific Abstract ePoster Gallery-Parotitis as Initial Presentation of Kawasaki Disease in 4-Month-Old

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This case report describes a 4-month-old Filipina infant who initially presented with 5 days of fever, irritability, and left jaw/neck swelling. Examination and ultrasound suggested parotitis, and she was started on antibiotics for presumed viral or bacterial parotitis. However, additional findings—including bilateral conjunctivitis with perilimbic sparing, migratory rash, persistent fever, cervical adenopathy, anemia, thrombocytosis, sterile pyuria, elevated inflammatory markers, and elevated BNP—raised concern for Kawasaki disease (KD), especially because KD can present atypically in infants under 6 months of age.<br /><br />Because KD is a systemic vasculitis with serious cardiac complications if untreated, early recognition is important. The team initiated IVIG and aspirin for suspected node-first KD. Her first echocardiogram showed low-normal systolic function without coronary dilation, but by hospital day 2, repeat echocardiography revealed dilation of the left anterior descending coronary artery. Due to persistent fever and evolving cardiac findings, infliximab was added. Subsequent echocardiograms showed improvement in coronary artery size, and she became afebrile and was discharged after 6 days. By day 7, echocardiogram, ECG, and laboratory values had normalized, with continued recovery at 4 months post-discharge.<br /><br />The report emphasizes that parotitis can be an unusual initial manifestation of Kawasaki disease. In infants, especially those younger than 6 months, KD may present incompletely and be mistaken for infection. Apparent parotitis that does not respond as expected to antibiotics, particularly when accompanied by fever and other inflammatory or mucocutaneous signs, should prompt evaluation for Kawasaki disease to reduce the risk of coronary artery complications.

Asset Subtitle

Sijia Zhang

Meta Tag

Author List Daniel Hershey, Sijia Zhang

Category Clinical Vignettes

Concept Kawasaki Disease

Concept Coronary Artery Complications

Concept Intravenous Immunoglobulin

Concept Infant

Concept Cardiac Complication

Distinguished Non-Finalist

Presenter Organization University of California, San Diego School of Medicine

Presenting Author Sijia Zhang

Track Pediatric

Keywords

Kawasaki disease

infant

parotitis

coronary artery dilation

IVIG

aspirin

infliximab

cervical adenopathy

sterile pyuria

conjunctivitis

Kawasaki Disease

Coronary Artery Complications

Intravenous Immunoglobulin

Infant

Cardiac Complication