Incomplete Kawasaki disease presenting primarily with cough: a case report and brief literature review

Abstract

Background: Kawasaki disease (KD) is an acute systemic vasculitis predominantly affecting children under 5 years of age. To prevent the development of cardiac aneurysms and their associated adverse outcomes, such as coronary artery dissection with subsequent bleeding, early recognition and treatment are of utmost importance. The classic early symptoms of KD include fever, conjunctival congestion, cracked lips, and others. However, these symptoms are not exclusive to KD and can also be observed in a variety of infectious diseases. Peeling of the skin on the hands, feet, fingers, and around the anus typically becomes evident around ten days after the onset of the disease or even later. Once complications occur, treatment may be ineffective. Hence, early diagnosis and timely treatment are essential to control disease progression, prevent further exacerbation of complications, and promote rapid lesion recovery.

Case presentation: A 3-year-old boy initially presented solely with sever cough symptoms, followed by fever, which are typical manifestations of a respiratory illness. Additionally, conjunctival hemorrhage developed during the course of the illness. Laboratory tests showed significant elevation in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Despite anti-infective treatment with ceftriaxone, the condition did not improve. The clinical presentation and laboratory findings were consistent with a diagnosis of incomplete Kawasaki disease (IKD). Immediately after treatment with intravenous immunoglobulin (IVIG) and aspirin, the patient's fever and cough symptoms subsided within the next two days. Cardiac ultrasonography at the time of discharge indicated that the coronary artery had healed. At the 1-month and 3-month follow-ups, the patient was in good general health.

Conclusions: It is uncommon for a patient with Kawasaki disease (KD) to initially present with a severe cough as the predominant symptom, especially in the absence of other classic clinical features and with poor response to anti-infective therapy. Therefore, in such cases, clinicians should maintain a high index of suspicion for incomplete Kawasaki disease (IKD) and promptly conduct coronary artery evaluations to avoid delays in diagnosis and treatment.

Keywords: Case report; Cough; Diagnosis; Incomplete Kawasaki disease; Kawasaki disease.

Fig. 1

Chest CT at admission showed bilateral lung inflammation

Fig. 2

A Echocardiography on hospital day 4 showed a left coronary artery diameter of 2.5 mm (Z = 0.96). B Echocardiography on hospital day 11 showed a left coronary artery diameter of 2.1 mm (Z = −0.21). C Echocardiographic follow-up one month after discharge confirmed a left coronary artery diameter of 2.1 mm (Z = −0.21)