A Case of Indolent Kawasaki Disease with Delayed Coronary Artery Lesions: The Role of Proactive Imaging.

Kawasaki Disease (KD) is an acute vasculitis primarily affecting children and can lead to coronary artery lesions (CALs) if not promptly diagnosed and treated. Indolent KD, characterized by spontaneous fever resolution without early intervention, poses diagnostic challenges as patients may not initially meet the complete diagnostic criteria, delaying treatment and increasing the risk of CAL development. We report a case of a 17-month-old boy with indolent KD who developed CAL on the 18th day of illness, necessitating IVIG therapy. Despite initial symptom resolution, echocardiographic monitoring revealed delayed coronary artery involvement, underscoring the importance of proactive imaging. This case highlights the need for frequent echocardiographic evaluation in indolent KD, particularly when clinical and laboratory findings are inconclusive. Serial imaging facilitates early detection of CALs, enabling timely IVIG therapy and potentially preventing disease progression. A structured follow-up strategy is crucial in managing indolent KD to reduce the risk of long-term cardiovascular complications.