Atypical Kawasaki disease Yap C-Y et al. CLINICS 2012;67(6):689-692 Figure 1 - The clinical presentation of a 10-year-old boy before treatment. Bilateral injected tonsils with a yellowish purulent coating (A). Ultrasound images of the bilateral neck masses suggested cervical lymphadenitis (B, C). aneurysm (Figure 3). The diameters of the dilated vessels were as follows: left main coronary artery (LMCA) 5.2 mm; left anterior descending artery 5.5 mm; left circumflex artery 4.4 mm; and right coronary artery (RCA) 6.5 mm. The patient was diagnosed with KD based on the echocardio- graphic findings and was readmitted. Immediate treatment with intravenous gammaglobulin was initiated (1 g/kg for 2 days), and the patient was subsequently discharged with a prescription for ongoing treatment with aspirin (5 mg/kg/ day) and dipyridamole (6 mg/kg/day). Testing before 3 discharge revealed the following: WBC count, 8,540/mm ; neutrophils, 55.5%; platelet count, 270,000/mm3; and erythrocyte sedimentation rate, 8 mm/h and 10 mm/2 h. These findings indicated that the inflammation associated with the disease was controlled. Follow-up echocardiography examinations during a 6- month period after discharge revealed diffuse coronary artery dilatation and aneurysms as follows: LMCA 4.8 mm and RCA 6.7 mm (1 month after discharge); LMCA 4.1 mm and RCA 6.2 mm (two months after discharge); and LMCA 3.9 mm and RCA 4.6 mm (six months after discharge). DISCUSSION The clinical manifestations of KD can be diverse. Indeed, recent case reports have highlighted atypical cases of KD involving patients presenting with symptoms such as severe shock (7) and pancreatitis (8). A recent case series has also highlighted the existence of KD in adults, indicating that age is not a defining characteristic of the disease (9). It is important that clinicians are made aware of atypical cases to facilitate prompt diagnosis and appropriate treatment. Not all patients with KD have symptoms that meet the classic diagnostic criteria. Children with KD exhibiting fever and fewer than four of the other characteristic symptoms, so-called atypical or incomplete KD, may develop coronary artery aneurysms. In the case described in this paper, a 10-year-old boy presented with fever, acute 690