A Misdiagnosed Atypical Kawasaki Disease: A Case Report

The diagnosis of atypical Kawasaki disease is a clinical challenge. Misdiagnoses or missed diagnoses for patients with atypical Kawasaki disease can potentially result in severe clinical outcomes. We report a rare case of atypical Kawasaki disease presenting symptoms similar to those of appendicitis and fulminant viral myocarditis but without any classic clinical features during the whole illness. A 4.5-year-old boy presented with acute abdominal pain and fever for 10 days. Exploratory laparotomy and appendectomy were performed after failed treatment with intravenous antibiotics, yet the persistent abdominal pain was not relieved, and cardiac arrest occurred after surgery. The echocardiography examination revealed a giant coronary artery aneurysm and reduced cardiac output in the third week after onset. Then the patient was diagnosed with atypical Kawasaki disease. Even after treatment with intravenous immunoglobulin, anticoagulation drugs and diuretics, the patient's heart dysfunction still progressed, and he had to undergo a coronary artery bypass graft. At the 2-year postoperative follow-up evaluation, the patient's heart function remained at New York Heart Association (NYHA) class I and normal growth was sustained. Improving the understanding of Kawasaki disease as a vasculitis syndrome may be helpful in reducing the misdiagnosis.