Incomplete Kawasaki disease (KD) is second most common systemic vasculitis presented with persistent fever in childhood. Systemic onset juvenile idiopathic arthritis (SoJIA) is a rare rheumatic arthritis characterized with spiking fever for more than 6 weeks with prominent painful joint swelling. KD may trigger or prodrome of SoJIA. Both diseases have overlapping clinical features and laboratory findings including fever, rash, lymphadenitis, thrombocytosis, arthralgia and coronary artery dilatation so that they could hardly be distinguished. We present 4 years old girl and 30 months old girl who presented with persistent fever, rash and arthralgia. They were initially diagnosed with incomplete KD and treated with intravenous immunoglobulin and steroids. Spiking fever and painful swelling of bilateral knee joints were noticed after 25days and 40days of illness. They were diagnosed with SoJIA followed by incomplete KD and treated with NSAIDs and MTX in addition. Neither coronary complication nor joint complication was noticed. Careful follow up is needed for patients with KD and arthralgia.
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