Dilemma in diagnosing incomplete Kawasaki disease in a resource limited setting

Abstract

Introduction and Importance: Kawasaki diseaseis an acute febrile systemic vasculitis that predominantly affects small to medium sized vessels and mostly occurs in children below five years of age. The morbidity and mortality mostly occur due to cardiac involvement. Case Presentation: We Present a Case of a 5-year-old male child from hilly region of Nepal who presented with fever for 7 days along with strawberry tongue and non-exudative conjunctivitis without rashes, extremity changes or lymphadenopathy. A suspicion of Incomplete Kawasaki Disease was made. The notable investigation findings were increased erythrocyte sedimentation rate, C-reactive protein, leukocyte count and platelets. Echocardiography showed normal findings. Based on the clinical features and supplemental laboratory findings, a diagnosis of incomplete Kawasaki disease was made. The patient improved after intravenous immunoglobulin andAspirin. Clinical Discussion: The main learning objective that we get from this case is the challenges in the diagnosis of Incomplete Kawasaki Disease in the resource limited setting like Nepal. Whether or not to start intravenous immunoglobulin is a dilemma for the physician in most of the cases of suspected incomplete Kawasaki disease, due to the high cost and poor availabilityof intravenous immunoglobulinin this setting. Hence, the use of inflammatory markers, supplemental laboratory findings together with the few diagnostic criteria met by the patienthelps in making a diagnosis and institute timely treatment with intravenous immunoglobulin and aspirin. Conclusion: Diagnosis of Kawasaki Disease in difficult in resource limited setting.