Recurrent incomplete Kawasaki disease with small-joint-predominant arthritis during the acute phase.
Kentaro Suzuki, Soichiro Ishimaru, Yuka Mihara et al.
✦ AI-curated · Sources linked
Case in brief
An adolescent boy presented on day 6 of illness with fever and left cervical lymphadenopathy, having a history of complete Kawasaki disease. He developed painful swelling in the left wrist and small joints of the fingers and toes, confirmed as synovitis via ultrasonography. Although fever resolved by day 12, arthritis persisted, leading to a diagnosis of incomplete Kawasaki disease on day 18. Treatment with intravenous immunoglobulin resulted in rapid improvement, and he was discharged without residual symptoms.
What made this case unusual
The case highlights the occurrence of small-joint-predominant arthritis during the acute phase of Kawasaki disease, which is atypical compared to the more common presentation of larger joint involvement.
Diagnostic / clinical pearl
Clinicians should be aware that Kawasaki disease can present with small-joint arthritis, particularly in the acute phase, which may complicate the differential diagnosis with systemic juvenile idiopathic arthritis.
Why it matters
This case underscores the importance of serial clinical reassessment in Kawasaki disease to accurately diagnose and manage atypical presentations.