Case Report: Kawasaki Shock Syndrome With Polycyclic Eruption: A Peculiar Brain Imaging

Kawasaki disease (KD) is a childhood vasculitis of unknown etiology. The present study describes a case of KD shock syndrome that occurred in an infant (age, 16 months) following 7 days of high fever and persistent rash characterized by target-like and purpuric skin lesions. The child developed neurological manifestations such as altered consciousness and irritability. Consequently, brain magnetic resonance imaging (MRI) was performed, revealing an inflammatory involvement of the anterior perforated substance and the hypothalamus. Cerebral involvement on brain MRI is rarely described in KD but when reported is characterized mostly by cerebral vasculitis. We illustrate for the first time in KD an inflammation in the brain not related to vasculitis, reporting peculiar neuroradiological findings. This last aspect has fascinated us in light of recent evidence about the immunological spectrum of Multisystem Inflammatory Syndrome in Children (MIS-C) and Kawasaki-like syndrome in the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) outbreak.

Automated summary

This study presents a case of KD shock syndrome in an infant with high fever and persistent rash, with brain involvement revealed on MRI, which is rarely reported in KD and typically associated with cerebral vasculitis. This unique inflammation in the brain not related to vasculitis highlights the complexity of inflammatory syndromes such as MIS-C and Kawasaki-like syndrome in the context of SARS-CoV-2 outbreak.