Atypical Kawasaki Disease in an Adolescent with Multivisceral Involvement

Abstract

Kawasaki disease (KD) is a vasculitis mostly seen in children aged less than 5 years. It can involve different organs and tissues. Its diagnosis is based on the clinical criteria of the American Heart Association (AHA). We report a case of a Moroccan adolescent with an atypical presentation of KD initially treated as typhoid fever. Gastrointestinal, renal, and pulmonary signs were the main clinical findings that made the diagnosis of KD challenging and delayed. The consequence was a severe cardiac damage with myocarditis and coronary artery dilation. KD is uncommon in adolescents, and it is important to recognize the atypical forms and the different presentations of KD in order to prevent the delay of diagnosis and treatment, and hence the cardiac complications.

Figure 1

Clinical symptoms in our patient. (a) Coated tongue. (b) Bilateral ocular redness (uveitis). (c) Periungual desquamation.

Figure 2

The timeline of the clinical case.

Figure 3

CT scan images showing (a) inflammation of the small bowel, air-fluid levels, reactional mesenteric lymphadenopathy, and (b), (c) right-sided pleurisy with bilateral pulmonary consolidation.

Figure 4

Echocardiographic images showing (a) mitral regurgitation, (b) low left ventricular ejection fraction at 43%, (c) pericardial effusion, and (d) 4 mm coronary dilatation (Z score +4).