Dental Assessment of Severe Lip Crusting Leading to Diagnosis of Incomplete Kawasaki Disease: A Case Report

Abstract

Kawasaki Disease (KD) is an acute vasculitis of unknown etiology that predominantly affects children under five years old. It is classically characterized by prolonged fever, conjunctival injection, cervical lymphadenopathy, polymorphous rash, extremity changes, and oral mucosal involvement. While strawberry tongue and lip erythema are well-documented oral findings, severe lip crusting with blackish discoloration is an uncommon presentation. A 2-year-old child was referred to the pediatric dental clinic for severe lip crusting and mucositis. Initially treated for an upper respiratory tract infection, the child developed persistent fever, bilateral conjunctival injection, cervical lymphadenopathy, and reduced oral intake. The oral examination revealed extensive blackish crusting over the lips, which bled upon touch. This manifestation was initially suspected to be a reaction to topical medication, but clinical correlation suggested it was a rare but classic oral presentation of KD. The patient was admitted for systemic management, including intravenous immunoglobulin (IVIG) and supportive dental care. Daily oral toileting and mucosal hydration were initiated to manage lip crusting, along with the application of Gengigel®. The patient showed progressive improvement with systemic and local interventions. Early diagnosis and interdisciplinary collaboration are crucial in managing KD to ensure appropriate management and prevent complications such as coronary artery aneurysms.