First Case of Terminal Ileitis Coexisting with Incomplete Kawasaki Disease

Kawasaki disease (KD), also referred to as mucocutaneous lymph node syndrome and infantile polyarteritis nodosa, is characterized by inflammation of small and medium-sized blood vessels across the body. It can manifest in various clinical features among pediatric patients admitted to general pediatric departments with fever, particularly those aged less than 5 years. Despite its relatively benign nature, it is crucial to promptly identify potential complications. We describe the case of a 10-month-old female patient admitted to the general pediatric department due to a 5-day history of fever peaking at 40.5 degrees C, diarrhea, and irritability. Physical examination revealed no conjunctivitis, cervical lymphadenopathy, or rash, but notable irritability and edematous induration on the dorsum of her hands and feet. Initial laboratory investigations showed elevated acute phase reactants, and radiological assessment indicated terminal ileitis. Considering the presentation consistent with incomplete KD, characterized by persistent fever, ill appearance, ileitis, hypoalbuminemia, and elevated acute phase reactants, we pursued further evaluation. Echocardiography revealed ecstatic and prominent coronary artery without dilation of the main coronary arteries. It is important to recognize that not all KD patients will exhibit all typical features, and presentations may vary. While inflammatory changes in multiple systems have been documented in KD, terminal ileitis has not been previously reported in pediatric patients.