Kawasaki disease (KD), an acute self-limiting vasculitis, is uncommon in Indian girls. An 18-month-old girl was admitted to our Pediatrics Department with history of high spiking fever for 9 days. On examination she was febrile, sick looking, extremely irritable and had erythematous rash over the trunk, extremities with erythema and swelling of hands, and bilateral non-exudative conjuncti-val injection. She had redness with cracking of lips, red strawberry tongue and erythema of oropharyngeal mucosa. There was no cervical lymphadenopathy. Crepts were present in the mammary and interscapular regions on the right side. Remaining examination was unremarkable.

Investigations on admission were: a total white blood cell count (TLC) was 30,600/cu mm, differential count (DLC) – P-58%, L-31%, M-11% and hemoglobin (Hb) 9.5 g/dL with normocytic red cells in peripheral blood film. ESR was 122 mm in 1st hour and platelet count was 7,02,000/cu mm. Smear for malarial parasite was negative. Blood sugar, electrolytes, coagulation profile, hemoglobin electrophoresis, renal and liver functions were normal. HIV serology, ELISA for tuber-culosis and filaria were negative. Throat swab, eye swab, urine and blood cultures did not show any growth. Cerebrospinal fluid analysis was normal and culture was sterile. X-ray chest was suggestive of interstitial pneumonia in upper zone and paracardiac mid-zone on the right side. There was no pleural effusion. Ultrasound abdomen was normal. Patient was empirically started on intravenous ceftrioxone. On 12th day of illness she developed periungual desqua-mation of all fingers. A diagnosis of KD was made. As intravenous gamma globulin (IVIG) could not be given due to economic constraints, the child was treated with aspirin in a dose of 100 mg/kg/day for 2-weeks. 2-D Echocardiography done on 18th day of illness showed a dilated (4.0-mm) left main coronary artery with an aneurysm of 6.0-mm diameter in its proximal segment. Right coronary artery was measuring 4.5 mm. ECG was normal. There was rapid improvement in her clinical status after starting aspirin. At the end of 2nd day of aspirin, she became afebrile, less irritable, the rash and oral changes had resolved, conjunctivitis had improved and chest was clear. Ceftriaxone was discontinued after 48 hours of starting of aspirin.

Periungual desquamation continued for two more days. She was put on low dose aspirin 5 mg/kg/day on 26th day of illness and was discharged. At two months of follow-up she is doing well clinically. 2-D Echocardio-graphy done showed a decrease in the size (3.6 mm) of left main coronary artery and the aneurysm in its proximal segment now measured 4.8 mm diameter. Right coronary artery was now measuring 3.4 mm.

Our patient had fever for more than five days, fulfilled four of the five classic diagnostic criteria described for KD and had CAA as well. Even three of the five criteria are sufficient to diagnose KD if coronary abnormalities develop(1). As compared to the Western and Oriental world CAA is very rare in Indian females which we report here for the first time.

In our case other associated feature was clinically apparent and radiologically confirmed interstitial pneumonia. There have been sporadic reports of pulmonary mani-festations that include retrospective findings of abnormal chest radiograph(2) or post-mortem pulmonary pathological findings(3). First and the only report of significant clinical pulmonary dysfunction with interstitial lung disease has been reported recently(4). Pulmonary complications in the form of interstitial lung disease, though rare, could be seen in KD.