Objective:

To report a case of febrile status epilepticus in setting of refractory Kawasaki disease (KD) triggered by preceding parvovirus B19 infection without any CNS involvement.

Background:

Kawasaki Disease has been rarely reported to be triggered by preceding parvovirus B19 infection and it is extremely rare for it to present with febrile status epilepticus without any evidence of concurrent meningoencephalitis. We present a case with this presentation.

Design/Methods:

Case report and review of literature

Results:

3-year-8-month-old Caucasian boy with no family history of KD, who was admitted to hospital ward with generalized tonic-clonic seizures in setting of high-grade fever lasting 15 minutes which were aborted by IV Midazolam given by paramedic staff. He developed febrile status epilepticus requiring intubation, transfer to ICU and multiple anti-epileptic drugs for abortion and maintenance, including levetiracetam, lacosamide, phenobarbital and phenobarbital drip. Basic CSF labs (protein, cell count, glucose and gram stain) were unremarkable for CNS infection while inflammatory markers were markedly elevated (ESR, CRP, Ferritin, etc). He had been diagnosed with KD and treated with IVIG a few weeks before presentation to our hospital, which did not result in complete resolution. He was diagnosed with refractory KD and treated with additional IVIG, followed by Anakinra and Prednisone resulting in complete resolution of symptoms of KD and recurrent seizures. He was weaned of anti-seizure medication. Extensive workup for additional infectious and rheumatological cause was negative. 

Conclusions:

KD without CNS involvement can present as febrile status epilepticus in rare situations and might be preceded by parvovirus B19 infection in patients with no familial predisposition to KD.