A 3-month-old infant has had fever for 10 days with irritability, poor feeding, and a faint maculopapular rash. CRP is 120 mg/L, ESR 85 mm/hr. Echocardiography reveals a 5 mm aneurysm in the left anterior descending coronary artery. Only 3 classic clinical criteria for Kawasaki disease are present. Which of the following is the correct classification?

• A Classic Kawasaki disease
• B Kawasaki disease shock syndrome
• C Atypical Kawasaki disease
• D Incomplete Kawasaki disease ✓

Explanation

Incomplete (atypical) Kawasaki disease is diagnosed when fever for 5 or more days with fewer than 4 principal clinical features are present, with laboratory or echocardiographic evidence of systemic inflammation. In infants under 6 months with prolonged fever and systemic inflammation with coronary changes, incomplete Kawasaki disease is the correct classification. Atypical Kawasaki disease is not a standard term; the correct term is incomplete.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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