Kawasaki disease with giant coronary aneurysms formation in a 3-month old infant: a case report and review of the literature

Kawasaki disease (KD) is an acute systemic vasculitis that affects medium-sized vessels, particularly the coronary arteries. KD predominantly affects children under 5 years of age. Main symptoms include fever, bilateral conjunctivitis, polymorphous exanthema, oropharyngeal mucous membranes changes, palmar and/or plantar erythema and edema, and cervical lymphadenopathy. KD can present with a few clinical features, which might lead to a delayed diagnosis, particularly in infants. When the therapy is delayed, the diagnosis is missed or in refractory cases, there is a higher risk of coronary artery aneurysms to be formed. We report a clinical case of a 3-month-old male who presented initially with fever and cervical lymphadenopathy in whom a bacterial infection was suspected and treatment with antibiotics was started. In the course of the disease erythema of the palms and soles and generalized erythematous rash developed. The diagnosis of KD was made on the 11th day of onset of symptoms and despite the treatment with two doses of intravenous immunoglobulin, high-doses corticosteroids and infliximab, during follow-up the infant developed giant coronary artery aneurysms. A comprehensive review of the literature concerning KD in infants is included. Clinical suspicion is required to diagnose KD in the youngest patients, as they are more likely to present with few features of the disease.