Incomplete Kawasaki Disease Presenting as Orbital Cellulitis in a Child.

Purpose: To describe a case of periorbital cellulitis as the manifestation of Kawasaki disease (KD).

Methods: A single case report.

Results: A 15-month-old child presented with fever and swelling around the eyes, initially diagnosed as orbital cellulitis. On examination, the child exhibited bilateral orbital swelling with conjunctival congestion, strawberry tongue, cracked lips, significant bilateral cervical lymphadenopathy, and perianal excoriation. Although many clinical features were compatible with KD, the diagnostic criteria for KD were not fully met. Despite 48 h of antibiotic therapy, the child continued to experience high-grade fever spikes. Consequently, the diagnosis was reviewed and reclassified as incomplete KD. The child was then administered intravenous immunoglobulin (IVIG) at a dosage of 2 g/kg over 10 h. Within 48 h of IVIG administration, the fever subsided and the periorbital swelling decreased.

Conclusions: The diagnosis of incomplete KD requires a high index of suspicion as the delay in diagnosis may lead to coronary involvement. Any young child with orbital cellulitis unresponsive to antibiotic therapy should be investigated for underlying KD.