Kawasaki disease in children with apparent increase in occurrence of incomplete and atypical forms

Background: Kawasaki disease (KD) is a common childhood vasculitis. Recent studies have shown an increase in proportions of children diagnosed with incomplete KD. Methods: Case records of 16 children with KD, registered from July 2019 to December 2020 in the department of pediatrics, Indira Gandhi Medical College, Shimla, India, were reviewed. Four children who had Kawasaki-like disease associated with Coronavirus disease 2019 were excluded from the study. Results: Sixteen children (11 boys, 5 girls;mean age 4.5 years) had KD. Eight (50%) children had incomplete KD. Fever (100%), oral changes (81.2%), rash (69%), desquamation (62.55), conjunctival injection (56.2%) and arthritis (31.2%) were common clinical features. Laboratory investigations showed neutrophilic leucocytosis (10/16), thrombocytosis (10/16), elevated erythrocyte sedimentation rate (12/16) and C-reactive protein (13/16). Six (37.5%) children had cardiac abnormalities. Three children had coronary artery aneurysms. Two children had pericardial effusion and 1 child had myocardial dysfunction. 14/16 children received intravenous immunoglobulin (IVIG). Two children received methylprednisolone pulse (30 mg/kg) followed by tapering dosages of prednisolone and 1 child was given injection infliximab (5 mg/kg), in addition to IVIG. Discussion: Fifty percent children in our cohort had incomplete KD and few children had atypical presentation. One child with KD had concomitant chicken pox. Another child had overlap of KD with HSP and 3 rd child developed insulin dependent diabetes mellitus (IDDM) 1 month after having KD. Five children in our cohort had arthritis. As compared to previous study from our centre, we found that KD is the most common childhood vasculitis at our centre with apparent increase in its occurrence and increase in the proportion of children with incomplete and atypical KD over the time. Conclusion: KD is the most common childhood vasculitis in our centre and apparent increase in its occurrence may be due to increased awareness and diagnosis of incomplete/atypical KD.