A triad of hypertension, heart failure, and glomerular injury in subacute Kawasaki disease: a case report and literature review.

Kawasaki disease (KD) is the leading cause of acquired pediatric heart disease, characterized by acute systemic vasculitis. We report a 7-year-6-month-old boy with typical KD [meeting the 2017 American Heart Association (AHA) diagnostic criteria] who responded completely to initial intravenous immunoglobulin (IVIG) therapy (2 g/kg), with rapid defervescence and normalized inflammatory markers. Despite this favorable initial response and no coronary abnormalities, he uniquely developed a triad of acute heart failure with cardiomegaly [New York Heart Association (NYHA) class II], severe hypertension (> 99th percentile), and early glomerular injury (elevated urinary albumin-to-creatinine ratio, urinary transferrin, and urinary albumin) during the clinically quiescent subacute phase. This "inflammatory-silent but vascular-loud" phenotype underscores that effective initial treatment and normalization of inflammatory markers do not equate to vascular safety, highlighting persistent endothelial dysfunction as a critical driver of morbidity. The case supports redefining subacute-phase monitoring to include blood pressure surveillance, comprehensive echocardiographic assessment of chamber dimensions and function, and screening for early glomerular injury.