{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T17:48:33Z","timestamp":1789753713987,"version":"4.0.1"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>Infants younger than 3 months old often present with incomplete Kawasaki Disease (KD), where not all the classical features are present. This makes the diagnosis challenging, as KD may be easily confused with other common pediatric conditions, such as viral infections, bacterial sepsis, or toxic shock syndrome. Moreover, the risk of developing coronary artery abnormalities is reportedly higher in younger infants, making timely diagnosis and treatment critical. Here we reported three cases of KD in infants under three months, each illustrating the challenges in diagnosis due to the absence of typical KD symptoms such as rash, conjunctivitis, and oral mucosal changes. Echocardiography played a pivotal role in identifying coronary artery abnormalities, leading to the diagnosis of incomplete KD in all cases. Clinicians should maintain a high index of suspicion for KD in any febrile infant, particularly when inflammatory markers are elevated. Early recognition and treatment are vital to prevent severe cardiovascular complications.<\/jats:p>","DOI":"10.3389\/fped.2025.1490921","type":"journal-article","created":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T05:29:09Z","timestamp":1751952549000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Case Report: Challenges in diagnosing Kawasaki disease in children under 3 months of age: a case series report"],"prefix":"10.3389","volume":"13","author":[{"given":"Duc Long","family":"Phi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thi Hoai","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khanh Linh","family":"Duong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cam Anh","family":"Nguyen Le","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duy Cuong","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Van Thuan","family":"Hoang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,8]]},"reference":[{"key":"B1","first-page":"178","article-title":"Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children","volume":"16","author":"Kawasaki","year":"1967","journal-title":"Arerugi"},{"key":"B2","doi-asserted-by":"publisher","first-page":"969495","DOI":"10.3389\/fcvm.2022.969495","article-title":"Risk factors and coronary artery outcomes of coronary artery aneurysms differing in size and emergence time in children with Kawasaki disease","volume":"9","author":"Liu","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"B3","article-title":"Kawasaki disease","volume-title":"StatPearls","author":"Owens","year":"2024"},{"key":"B4","doi-asserted-by":"publisher","first-page":"202","DOI":"10.3345\/kjp.2012.55.6.202","article-title":"Epidemiology of Kawasaki disease in infants 3 months of age and younger","volume":"55","author":"Lee","year":"2012","journal-title":"Korean J Pediatr"},{"key":"B5","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1186\/s13052-023-01478-9","article-title":"Very early onset of coronary artery aneurysm in a 3-month infant with Kawasaki disease: a case report and literature review","volume":"49","author":"Jiao","year":"2023","journal-title":"Ital J Pediatr"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e481","DOI":"10.1161\/CIR.0000000000001295","article-title":"Update on diagnosis and management of Kawasaki disease: a scientific statement from the American heart association","volume":"150","author":"Jone","year":"2024","journal-title":"Circulation"},{"key":"B7","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/j.jpeds.2016.09.052","article-title":"Postnatal risk of acquiring Kawasaki disease: a nationwide birth cohort database study","volume":"180","author":"Wu","year":"2017","journal-title":"J Pediatr"},{"key":"B8","doi-asserted-by":"publisher","first-page":"397","DOI":"10.3389\/fped.2020.00397","article-title":"Kawasaki disease in infants in the first 3 months of age in a Mexican population: a cautionary tale","volume":"8","author":"Garrido-Garc\u00eda","year":"2020","journal-title":"Front Pediatr"},{"key":"B9","doi-asserted-by":"publisher","first-page":"13948","DOI":"10.3390\/ijms241813948","article-title":"Diagnosis, progress, and treatment update of Kawasaki disease","volume":"24","author":"Kuo","year":"2023","journal-title":"Int J Mol Sci"},{"key":"B10","doi-asserted-by":"publisher","first-page":"470","DOI":"10.3389\/fped.2020.00470","article-title":"Characteristics and indications of Kawasaki disease among infants under 6 months","volume":"8","author":"Tang","year":"2020","journal-title":"Front Pediatr"},{"key":"B11","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1097\/01.inf.0000202067.50975.90","article-title":"Characteristics of Kawasaki disease in infants younger than six months of age","volume":"25","author":"Chang","year":"2006","journal-title":"Pediatr Infect Dis J"},{"key":"B12","doi-asserted-by":"publisher","first-page":"550","DOI":"10.4070\/kcj.2016.46.4.550","article-title":"Clinical characteristics of Kawasaki disease in infants younger than six months: a single-center study","volume":"46","author":"Yoon","year":"2016","journal-title":"Korean Circ J"},{"key":"B13","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1186\/s12887-019-1695-0","article-title":"Kawasaki disease in infants less than one year of age: an Italian cohort from a single center","volume":"19","author":"Mastrangelo","year":"2019","journal-title":"BMC Pediatr"},{"key":"B14","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1186\/s12887-024-04961-2","article-title":"Guideline for the diagnosis and treatment of incomplete Kawasaki disease in children in China","volume":"24","author":"Jiao","year":"2024","journal-title":"BMC Pediatr"},{"key":"B15","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1001\/archpedi.154.5.453","article-title":"The differentiation of classic Kawasaki disease, atypical Kawasaki disease, and acute adenoviral infection: use of clinical features and a rapid direct fluorescent antigen test","volume":"154","author":"Barone","year":"2000","journal-title":"Arch Pediatr Adolesc Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1007\/s00431-020-03752-y","article-title":"Value of serial echocardiography in diagnosing Kawasaki\u2019s disease","volume":"180","author":"H\u00f6rl","year":"2021","journal-title":"Eur J Pediatr"},{"key":"B17","doi-asserted-by":"publisher","first-page":"593435","DOI":"10.3389\/fped.2020.593435","article-title":"Effect of early intravenous immunoglobulin therapy in Kawasaki disease: a systematic review and meta-analysis","volume":"8","author":"Yan","year":"2020","journal-title":"Front Pediatr"},{"key":"B18","doi-asserted-by":"publisher","first-page":"377","DOI":"10.3345\/kjp.2013.56.9.377","article-title":"Kawasaki disease in infants","volume":"56","author":"Yeom","year":"2013","journal-title":"Korean J Pediatr"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1490921\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T05:29:11Z","timestamp":1751952551000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1490921\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,8]]},"references-count":18,"alternative-id":["10.3389\/fped.2025.1490921"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1490921","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,8]]},"article-number":"1490921"}}