Department of Pediatrics, Children's of Mississippi, University of Mississippi Medical Center, Tupelo, MS, USA.
North Mississippi Medical Center, Tupelo, MS, USA.
Am J Case Rep. 2021 Nov 14;22:e933356. doi: 10.12659/AJCR.933356.
BACKGROUND Kawasaki disease (KD) is an acute inflammatory vasculitis, which occurs mostly in childhood, predominantly between the ages of 6 months and 5 years. The incidence of coronary artery abnormalities associated with KD has decreased from 25% to 4% as a result of timely diagnosis and treatment with intravenous immunoglobulin (IVIG). Infants ≤6 months of age are the most likely to develop prolonged fever without the other clinical criteria for KD, and diagnosis can sometimes be challenging or delayed. They are therefore at particularly high risk of developing coronary artery abnormalities. CASE REPORT A 2-month-old male infant with no significant medical history initially presented with a history of nasal congestion, right conjunctivitis, red lips, and 1 loose stool in the pre-COVID-19 era. He was diagnosed with otitis media and was started on oral amoxicillin. By day 7 of fever, he had developed symptoms and signs and laboratory findings consistent with Kawasaki disease, which is rare in this age group. His echocardiogram showed dilated proximal left anterior descending and right coronary arteries. He was successfully treated, and his most recent echocardiogram, performed 17 months after his treatment, showed remarkable improvement in the coronary arteries. CONCLUSIONS Kawasaki disease in children less than 6 months of age is still rare, and the presentation can sometimes make the diagnosis somewhat challenging. Increased clinical suspicion is required for recognition in the youngest patients, as they are more likely to present with few features of KD. Early diagnosis and treatment are needed to prevent or minimize the risk of significant coronary artery abnormalities.
川崎病（KD）是一种急性炎症性血管炎，主要发生在儿童期，多发生在 6 个月至 5 岁之间。由于及时诊断和静脉注射免疫球蛋白（IVIG）治疗，与 KD 相关的冠状动脉异常发生率已从 25%降至 4%。6 个月以下的婴儿最有可能出现持续发热而无其他川崎病的临床标准，诊断有时可能具有挑战性或延迟。因此，他们特别容易发生冠状动脉异常。
一名 2 个月大的男性婴儿，无明显病史，最初出现鼻塞、右眼结膜炎、嘴唇发红和 1 次稀便，当时处于 COVID-19 之前的时期。他被诊断为中耳炎，并开始口服阿莫西林。发热第 7 天，他出现了符合川崎病的症状和体征以及实验室检查结果，这种情况在这个年龄段很少见。他的超声心动图显示左前降支近端和右冠状动脉扩张。他成功接受了治疗，最近一次治疗后 17 个月的超声心动图显示冠状动脉明显改善。
6 个月以下儿童的川崎病仍然很少见，其表现有时会使诊断有些困难。对于最小的患者，需要提高临床警惕性以识别该病，因为他们更有可能出现较少的川崎病特征。需要早期诊断和治疗，以预防或最小化发生严重冠状动脉异常的风险。
