ATYPICAL KAWASAKI DISEASE IN AN INFANT: A CASE STUDY OF DIAGNOSTIC CHALLENGES AND DISCHARGE AGAINST MEDICAL ADVICE
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6173Keywords:
Atypical Kawasaki Disease, Pediatric Vasculitis, Discharge Against Medical Advice (DAMA), Health Communication, Patient ComplianceAbstract
Objective: This case study evaluates the diagnostic difficulties and socio-medical challenges encountered during the sequential hospitalization of an 11-month-old infant with atypical Kawasaki disease (AKD).
Methods: A retrospective review of medical records, laboratory values, imaging studies, and documented clinical interactions was conducted at a regional hospital.
Results: The patient initially presented with isolated acute febrile cervical lymphadenopathy. A recent routine Varicella immunization was noted in the medical history. The clinical trajectory was confounded by early corticosteroid exposure for airway stridor and a congenital bicuspid aortic valve with an associated dilated ascending aorta, leading to the initial exclusion of Kawasaki disease. Upon readmission with delayed periungual desquamation and borderline left anterior descending coronary artery Z-scores, a diagnosis of incomplete vasculitis was established, and intravenous immunoglobulin (IVIG) therapy (total 1.65 g/kg) was completed. However, during both admissions, the patient’s parents demanded immediate discharge against medical advice (DAMA) upon observing temporary symptomatic relief, equating clinical improvement with full recovery.
Conclusion: Incomplete clinical criteria and co-existing structural cardiac anomalies can cause significant diagnostic delays in infant vasculitis. Furthermore, this case suggests that parental interpretation of early symptomatic improvement may contribute to DAMA decisions, highlighting the need for highly specific risk communication regarding invisible cardiovascular complications.
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Copyright (c) 2026 Mikołaj Dubiel, Mateusz Kałwik, Iga Klepacz, Aleksandra Lorent, Dominika Groth, Martyna Rykowska
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