Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Jul 3;16(1):43.
doi: 10.1186/s12969-018-0263-8.

Kawasaki Disease in the neonate: case report and literature review

Fajer Altammar  1 , Bianca Lang  2
Affiliations
Review

Kawasaki Disease in the neonate: case report and literature review

Fajer Altammar et al. Pediatr Rheumatol Online J. .

Abstract

Background: Kawasaki Disease (KD), the leading cause of acquired heart disease in children in the developed world, is extremely rare in neonates. We present a case of incomplete KD in a neonate and a review of the literature on neonatal KD.

Case presentation: A previously healthy full term 15 day old Caucasian male with an unremarkable antenatal and perinatal history, presented on Day 2 of illness with fever, rash, irritability, and poor feeding. Examination revealed fever (39.6C), tachycardia, tachypnea, extreme irritability, and a generalized maculopapular rash, but was otherwise normal. His complete blood count, CRP and ESR were normal. Empiric intravenous antibiotics and acyclovir resulted in no improvement. On day 4, he had ongoing fever and developed recurrent apnea, required supplemental oxygen, and was transferred to the pediatric intensive care unit. On day 6, he developed bilateral non-purulent conjunctivitis, palmar erythema, bilateral non-pitting edema and erythema of his feet, and arthritis. His full septic work-up and viral studies were negative. On Day 7 he was treated with intravenous immunoglobulin, and over the next 48 h his symptoms including extremity edema resolved, he no longer required supplemental oxygen, and fever did not recur. On day 9 of illness he had marked thrombocytosis. Subsequently, he developed distal extremity desquamation. Repeated echocardiograms excluded the presence of coronary artery aneurysms (CAA).

Conclusions: We believe this to be a rare case of incomplete KD in a neonate, in which timely IVIG administration led to resolution of the acute illness and may have prevented CAA. A comprehensive English-language medical literature review of KD presenting in the neonatal period revealed only fifteen case reports. Cases often presented with incomplete KD, and a number had atypical laboratory features including a normal CRP in the acute phase, similar to what was seen in our patient. This case and our literature review should increase awareness that KD can rarely occur in neonates, often presenting atypically. Recognizing KD in a neonate enables appropriate treatment that can result in resolution of symptoms and may decrease the risk of cardiac complications.

Keywords: Diagnosis; Infant; Kawasaki; Neonate; Newborn.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The local research ethics board at the IWK Health Centre was consulted prior to undertaking this case report. Formal ethics approval for the project was waived; however, as is standard at the IWK Health Centre, written informed consent was obtained from the parent of the infant presented in the case report.

Consent for publication

As per the IWK Health Centre research ethics board recommendation, written “consent to be included in a case report” was obtained from the parent of the infant reported. The consent form states that information about the child’s illness will be published and available to other people, including health care professionals and the general public.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Photograph demonstrating extremity changes including marked non-pitting edema and erythema of foot
See this image and copyright information in PMC

References

    1. McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Council on Epidemiology and Prevention et al. Diagnosis, treatment, and long-term Management of Kawasaki Disease: a scientific statement for health professionals from the American Heart Association. Circulation. 2017;135(17):e927–e999. doi: 10.1161/CIR.0000000000000484. - DOI - PubMed
    1. Furusho K, Nakano H, Shinomiya K. High-dose intravenous gammaglobulin for Kawasaki disease. Lancet. 1984;2:1055–1057. doi: 10.1016/S0140-6736(84)91504-6. - DOI - PubMed
    1. Newburger JW, Takahashi M, Burns JC. Treatment of Kawasaki syndrome with intravenous gamma globulin. N Engl J Med. 1986;315:341–347. doi: 10.1056/NEJM198608073150601. - DOI - PubMed
    1. Tsuchida S, Yamanaka T, Tsuchida R, Nakamura Y, Yashiro M, Yanagawa H. Epidemiology of infant Kawasaki disease with a report of the youngest neonatal case ever reported in Japan. Acta Paediatr. 1996;85(8):995–997. doi: 10.1111/j.1651-2227.1996.tb14201.x. - DOI - PubMed
    1. Hangai M, Kubota Y, Kagawa J, Yashiro M, Uehara R, Nakamura Y, et al. Neonatal Kawasaki disease: case report and data from nationwide survey in Japan. Eur J Pediatr. 2014;173(11):1533–1536. doi: 10.1007/s00431-014-2347-x. - DOI - PubMed

MeSH terms

Substances