DOI: https://doi.org/10.36347/sjmcr.2026.v14i09.032

Pages: 2098-2101

Acute appendicitis is uncommon in young children and frequently presents atypically, with abdominal signs that may be minimal or absent, which can lead to diagnostic delay and a higher rate of complications. We report the case of a previously healthy 2-year-old girl admitted for fever reaching 39°C, evolving for eight days without digestive complaints. On admission she was febrile at 38.8°C, hypotonic, and hemodynamically and respiratory stable, with tenderness in the right iliac fossa. Cutaneous and mucosal examination showed a cheilitis, and the clinical picture initially suggested incomplete Kawasaki disease; echocardiography was normal, a first abdominal ultrasound performed during the fever work-up was unremarkable, and the patient received intravenous immunoglobulin, aspirin, and empirical antibiotic therapy. Because fever persisted, clinical reassessment and repeat imaging were performed: abdominal ultrasound demonstrated a thickened, dedifferentiated laterocecal appendix with an adjacent poorly organized collection, and contrast-enhanced computed tomography confirmed complicated acute appendicitis with a distal abscessed collection containing a stercolith. Laboratory investigations showed a marked inflammatory syndrome (erythrocyte sedimentation rate 78 mm/h, elevated C-reactive protein) with microcytic anemia and thrombocytosis. The patient underwent surgical management with a favorable postoperative course. This case highlights that complicated appendicitis can present as isolated prolonged fever in young children and should remain part of the differential diagnosis of incomplete Kawasaki disease, particularly when abdominal signs are absent or non-specific. Repeated clinical examination and imaging are key to a timely diagnosis.