To explore diagnostic features of Kawasaki disease shock syndrome (KDSS) complicated with reversible splenial lesion syndrome (RESLES).

The clinical data of a pediatric patient with KDSS complicated with RESLES diagnosed in Women and Children′s Hospital, Qingdao University in May 25, 2022 were retrospectively analyzed. The diagnostic features of KDSS with RESLES were summarized and relevant literatures were reviewed.

The 11-year-old boy was admitted to hospital because of dizziness, fever for 2 days and delirium once. On admission, his blood pressure was normal, but his cervical lymph nodes were enlarged, and he had positive neck resistance. In terms of laboratory tests, C-reactive protein level and erythrocyte sedimentation rate increased while serum sodium level decreased. Following admission, he was treated with anti-infection and nerve nourishment medications. On the third day, conjunctival congestion, rashes, bayberry tongue, red lip chapping, red swelling of hands and feet were appeared, which were associated with Kawasaki disease (KD). MRI of the head showed the splenium of the corpus callosum with slightly decreased T₁ and slightly increased T₂ signals in the pressure area, with high signal intensity on DWI. Based on these findings, he was diagnosed with RESLES. On the fourth day, hypotension was observed. Meanwhile, ultrasonography revealed that the motion of the left ventricular wall of the heart was slightly diminished, with multiple serosal effusions. KDSS was diagnosed and treated with dobutamine to raise blood pressure and glucocorticoid for anti-inflammatory, and fluid for resuscitation, after which shock was reversed and KD-related symptoms gradually faded within ten days. On the 14th day, cranial MRI revealed that the aberrant signal had disappeared. Literatures were searched from CNKI, Wanfang, VIP and PubMed databases until December 31, 2023, and a total of 14 literatures were retrieved, including 12 foreign literatures and 2 Chinese literatures. A total of 19 children were reported, of which 2 were Chinese. One was definitely reported to have hypotension.

KD complicated with RESLES is rare in children, the clinical symptoms are varied and atypical, the corpus callosum injury is reversible, and the prognosis is good after active treatment. Increasing awareness of this condition can improve physicians′ diagnostic abilities and provide early standardized treatment for the patient.