To the Editor: Kawasaki disease (KD) is an emerging health ailment affecting children worldwide, especially in Japan [1]. Along with cardiovascular impairments, the other atypical symptoms of KD comprise mumps, pleural effusion, and hepatitis [2,3,4].

In this case study, a 4-y-old boy, examined for a higher body temperature and severe earache in the right ear at the regional hospital in China, was admitted and treated at the Shaanxi Provincial People’s Hospital. The patient showed elevated heartbeats (108 beats/per min) and respiratory rate (24 breaths/per min) with an oxygen saturation level of 99% without exhibiting any adverse clinical signs like whole-body skin rash, lymphadenopathy, and hyperemia of the conjunctiva in the eyes. Later, otitis media with acute purulent tonsillitis was diagnosed in the patient with the auscultation of lungs diagnosed coarse without dry and wet rales and cardiovascular impairments.

In the early stages, persistent fever with diffuse congestion of oral mucosa and hyperemic conjunctiva in the eyes was diagnosed. Upon exposure to anti-inflammatory methylprednisolone, the patient’s earache significantly reduced but there was no improvement in fever condition. Meanwhile, the patient developed severe body rashes on the anterior chest and back skin with edema on the left foot. The cardiac color Doppler ultrasound confirmed the incidence of KD with profound widening of the inner diameter of the double coronary trunk and left anterior descending artery with a Z score = 1.5. The patient showed a promising recovery from fever and otitis media ailment after being exposed to human immunoglobulin (IgG at dose: 2 g/kg body weight) and furosemide (at dose 1 mg/kg body weight) treatments, attenuated coronary artery damage and preloading of heart, respectively. Nevertheless, the patient showed cardiovascular and auditory impairments with noticeable congestion in the left ear drum subjected to long-term clinical follow-up. In summary, otitis media could be a notable atypical symptom of KD, demanding early diagnosis.