Challenges in diagnosing Kawasaki disease in children under 3 months of age: A case series report

Duc Long Phi¹Thi Hoai Nguyen²Khanh Linh Duong¹Cam Anh Nguyen Le¹Duy Cuong Nguyen¹Van Thuan Hoang^1*

• ¹Thai Binh University of Medicine and Pharmacy, Thái Bình, Vietnam
• ²Thai Binh Pediatric Hospital, Thai Binh, Vietnam

Infants younger than 3 months old often present with incomplete Kawasaki Disease (KD), where not all the classical features are present. This makes the diagnosis challenging, as KD may be easily confused with other common pediatric conditions, such as viral infections, bacterial sepsis, or toxic shock syndrome. Moreover, the risk of developing coronary artery abnormalities is reportedly higher in younger infants, making timely diagnosis and treatment critical. Here we reported three cases of KD in infants under three months, each illustrating the challenges in diagnosis due to the absence of typical KD symptoms such as rash, conjunctivitis, and oral mucosal changes. Echocardiography played a pivotal role in identifying coronary artery abnormalities, leading to the diagnosis of incomplete KD in all cases. Clinicians should maintain a high index of suspicion for KD in any febrile infant, particularly when inflammatory markers are elevated. Early recognition and treatment are vital to prevent severe cardiovascular complications.