Case Report Kawasaki Shock Syndrome in a 12-Year-Old Girl Mimicking Septic Shock Vindika Prasad Sinhabahu, 1 Janani Suntharesan, 2 and Dimuthu Saraji Wijesekara 1 1 Professorial Paediatric Unit, Colombo South Teaching Hospital, Kalubowila, Sri Lanka 2 Professorial Paediatric Unit, Lady Ridgeway Hospital for Children, Colombo, Sri Lanka Correspondence should be addressed to Vindika Prasad Sinhabahu; sinbad.lk@gmail.com Received 1 September 2016; Revised 21 November 2016; Accepted 1 December 2016 Academic Editor: Lawrence Yamuah Copyright © 2016 Vindika Prasad Sinhabahu et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Kawasaki disease is diagnosed when fever lasts for more than 5 days with the presence of four out of fve of the following clinical features: bilateral conjunctival congestion, changes in the lips and oral cavity, polymorphous exanthem, changes in peripheral extremities, and acute nonpurulent cervical lymphadenopathy (Nakamura et al., 2012). Te average age of onset is 2 years and 90% of patients are below 5 years of age. Boys are more afected than girls (Cox and Sallis, 2009). Tis case report describes an adolescent female who was initially managed as having septic shock and subsequently found to have Kawasaki shock syndrome. 1. Case Report A 12-year-old girl presented with high spiking fever (103 ∘ F) for 3 days with headache, body aches, and an itchy rash for one day. Tere was no bleeding from gums, skin, urine, or stools. She did not have any urinary or respiratory symptoms. Tere was no contact history of fever or rash. She had a past history of simple febrile convulsions. She did not give a history of any known allergies, atopy, or asthma. Examination revealed a febrile ill child with cervical lymphadenopathy and urticarial rash over the body which changed in the distribution with fever spikes (Figure 1). Her peripheries were warm and pulse rate was 92/min. Blood pressure was 100/70 mmHg. Respiratory, neurological, and abdominal examinations were normal. Tere was no clinical evidence of central nervous system infections. Investigations on admission showed white blood cell (WBC) count of 5580/mm 3 with 85% neutrophils and plate- let (Plt) count of 116000/mm 3 , C-Reactive Protein (CRP) of 161 mg/l, and Erythrocyte Sedimentation Rate (ESR) of 40 mm/1st hour. Summary of investigations is shown in Table 1. Child was initially managed as having viral fever with the possibility of Dengue fever. She was treated with IV cefotaxime as for sepsis when high spiking fever continued with high CRP. On Day 4 of illness, child developed nonpurulent con- junctivitis with periorbital oedema. She was noted to have haemodynamic instability with hypotension and tachycardia. She received ICU care and needed two inotropes to maintain her haemodynamic stability for 3 days (Day 4–Day 6). As the inotropes were given for short duration, signifcant side efects were absent. Her urine output was normal throughout the illness. With the presence of fever, rash,and haemody- namic instability, viral myocarditis, toxic shock syndrome, and Steven Johnson syndrome were considered as possible diagnosis compared to atypical Kawasaki disease (KD) with the evolving clinical situation on Day 4 of illness. 2D Echo on Day 8 of illness showed anteroseptal hypoki- nesia with dilated lef anterior descending (LAD) artery with normal Lef ventricular and right ventricular function and no pericardial efusion with a negative troponin I and CK-MB. LAD diameter was 2.3 mm with dilated area with a diameter of 3.5 mm. Alanine transaminase (ALT) and aspartate transaminase (AST) were 86 U/l and 115 U/l on Day 4 which persisted above the reference range till Day 16 of illness. Serum bilirubin was 12 mg/dl on Day 4. Ultrasound scan showed bilateral pleural efusions and mod- erate ascites without hepatosplenomegaly. Repeated blood cultures did not reveal any bacterial growth. Serology for measles, leptospirosis, rubella, Dengue, Epstein-Barr virus, Hindawi Publishing Corporation Case Reports in Infectious Diseases Volume 2016, Article ID 4949036, 3 pages http://dx.doi.org/10.1155/2016/4949036