Unusual Presentation of Atypical Kawasaki Disease in a Child with Thrombocytopenia and Spontaneous Femoral Artery Leak: A Case Report

Kawasaki disease (KD) is an acute systemic vascular disease that affects mostly medium sized and small vessels. The most serious of which is coronary artery disease. Vasculitis involves proliferative granulomatous inflammation and resolves by cicatrization if not treated. It is generally a self-limited disease and its highest incidence is in children under five years.  The diagnostic criteria include the presence of fever for at least 5 days along with four of five other clinical features (rash, mucositis, conjunctival injection, cervical lymphadenopathy or extremity changes). Atypical Kawasaki disease includes patients who meet only 2 or 3 of the 5 criteria for diagnosis. We here report a 4- year old male patient who presented with fever, mucositis, perineal rash and evidence of de novo femoral vasculitis leading to spontaneously leaking femoral arteritis. His complete blood count revealed thrombocytopenia. The patient fulfilled the criteria for the diagnosis of atypical Kawasaki Disease.  He received intravenous immunoglobulins and aspirin in anti-inflammatory doses and his condition improved. We report this unusual presentation of Kawasaki disease with spontaneous femoral artery leak, rash and thrombocytopenia. Diagnosis of atypical Kawasaki disease is very challenging but essential as initiation of specific management is life-saving.