Afebrile Kawasaki disease: A case report

Abstract

Objective: Kawasaki disease (KD) is an acute, self-limiting vasculitis and the most common cause of acquired heart disease in children under 5 years old. Despite over 50 years of research, the etiology and long-term prognosis of KD remain unclear.

Case presentation: A 2-year-7-month-old boy presented with all the typical KD symptoms, including conjunctival injection, cracked lips, strawberry tongue, and membranous desquamation of the fingers and toes, but without fever. The patient was admitted with a 9-day history of peeling skin on his fingers, and no history of illness or fever in the past two weeks. Laboratory tests revealed elevated platelet count. An echocardiogram showed normal coronary arteries. The patient was diagnosed with KD and treated with low-dose aspirin and dipyridamole. He was discharged on the third day and showed complete symptom resolution and normal coronary arteries at follow-up.

Conclusions: This case report describes an instance of afebrile KD, emphasizing the need for clinical vigilance and comprehensive assessment for diagnosis and treatment. Afebrile KD poses a diagnostic challenge as fever is a major diagnostic criterion. However, clinicians should consider afebrile KD when other clinical features and laboratory results suggest KD, and initiate appropriate treatment to prevent severe complications like coronary artery lesions. This case underscores the importance of early diagnosis, timely intervention, and multidisciplinary team collaboration for effective management of KD.