kawasaki disease ( kd ) is an acute systemic vasculitis of unknown cause that occurs primarily in children and rarely in adults . in the absence of specific laboratory tests ,
we report an unusual case of an elderly man with several unique features of incomplete kd .
a 75-year - old white man was admitted to our hospital for a 3-week history of fever and poor general condition . his past medical history included hypertension , hyperlipidemia , myocardial infarction , and a coronary artery bypass graft surgery 2 years ago .
the patient was febrile ( 39c ) , and physical examination revealed bilateral nonpurulent conjunctivitis , red and cracked lips ( fig . 
 1 ) , and slightly edematous erythema with desquamation of the hands and feet ( fig . 

laboratory tests revealed anemia ( hemoglobin 8.5 g / dl ) , hypoalbuminemia ( 2.6 g / dl ) , elevated erythrocyte sedimentation rate ( esr ) and c - reactive protein ( crp ) ( 83 mm / h and 100.3 mg / l , respectively ) , elevated alanine aminotransferase ( 56 iu / l ; normal < 40 ) , and sterile leukocyturia ( 30 cells/l ) .
serological assays for human immunodeficiency virus , hepatotropic viruses , epstein - barr virus , cytomegalovirus , and antinuclear antibodies were negative .
the patient was subsequently treated with an intravenous immunoglobulin infusion ( 1 g / kg for 2 days ) and high - dose aspirin ( 3 g / day ) .
the fever remitted within 3 days , and within 1 week , the laboratory abnormalities returned to normal and mucocutaneous lesions improved dramatically .
low - dose aspirin , which the patient had taken since his bypass surgery , was then restarted .
kd is defined as the presence of a fever for 5 days and 4 of the 5 major clinical features : conjunctivitis , oral mucosal changes , polymorphous rash , palmoplantar erythema with desquamation , and cervical lymphadenopathy .
incomplete kd refers to patients who do not fulfill the classic criteria of 4 of the 5 findings and in whom alternative diagnoses have been ruled out . in adults , the main differential diagnoses
the higher prevalence of coronary artery lesions in patients with incomplete kd reflects difficulties in diagnosis and delays in treatment .
although adults are less frequently affected by coronary aneurysms compared with children ( 5 vs. 20% , respectively ) , establishing the diagnosis of incomplete kd and initiating treatment is essential . in 2004 ,
a multidisciplinary committee of experts proposed an algorithm to diagnose incomplete kd in children . for pediatric patients with a fever for 5 days and <
4 classical criteria of kd , laboratory tests , including crp and esr , should be obtained . in patients with elevated crp (
30 mg / l ) and/or esr ( 40 mm / h ) levels who fulfill 3 supplemental laboratory criteria [ including albumin 3.0 g / dl , anemia , elevation of alanine aminotransferase , 450,000/mm platelets after 7 days , white blood count 15,000/mm , and sterile pyuria ( 10 cells / high - power field ) ] , intravenous immunoglobulin and aspirin should be instituted and echocardiography should be performed .
our case emphasizes the importance of considering kd at any age , even among elderly individuals .
this case also highlights the usefulness of the algorithm proposed for children to diagnose incomplete kd in adults .
 kawasaki disease ( kd ) is a systemic vasculitis of unknown etiology , affecting predominantly young children . here 
 , we describe an unusual case of a 75-year - old man with several unique features of incomplete kd . 
 healthcare professionals should therefore be aware of the importance of considering kd at any age , even among elderly individuals . 
 this case also highlights the usefulness of the algorithm proposed for children to diagnose incomplete kd in adults . 
Introduction
Case Presentation
Discussion
Disclosure Statement