Fatal incomplete Kawasaki disease in a six-month-old infant from Ethiopia: a case report

Abstract Background Kawasaki disease (KD) is an acute systemic vasculitis of childhood and the leading cause of acquired heart disease in children in developed countries. Infants frequently present with incomplete disease, resulting in delayed diagnosis and increased risk of coronary complications. Data on KD from Africa, particularly Ethiopia, remain extremely limited. This is the first reported case of incomplete KD in an Ethiopian infant. Case presentation A fatal case of a six-month-old Ethiopian female infant with missed incomplete Kawasaki disease is reported. At four months of age, she presented with nine days of unexplained fever and markedly elevated inflammatory markers but lacked the classic clinical features of KD. The diagnosis was not considered and she was empirically treated for presumed infectious causes. Two months later she presented in cardiogenic shock. Echocardiography revealed giant coronary aneurysms with intraluminal thrombosis and severely depressed left ventricular systolic function. Despite intensive care support, the patient died within 12 hours of admission. Conclusion This case highlights the devastating consequences of missed and delayed recognition of incomplete KD in young infants. Clinicians must maintain a high index of suspicion for KD in infants with prolonged unexplained fever and elevated inflammatory markers, even in the absence of classic clinical features. Strict adherence to established diagnostic algorithms is essential to prevent catastrophic cardiac complications, particularly in low-resource settings where awareness of KD remains limited.