Juan and Sarah Alvarado Are Suing Mission Hospital, Saying Doctors Brushed Off Kawasaki Disease Before Their Son Developed Heart Aneurysms

Juan and Sarah Alvarado say they asked a hospital doctor one direct question when their little boy’s fever came back: could this be Kawasaki disease? According to a lawsuit the couple filed Nov. 5 in Buncombe County Superior Court, the answer was no, and no test was ordered to rule it out. Their son, Silas, is now 2, and the suit says he was left with aneurysms in the arteries that feed his heart, a condition that will need monitoring for life.

The case was first reported by the Asheville Citizen Times, in a story republished on Yahoo News. Everything below is what the lawsuit alleges. None of it has been tested in court.

The Question the Parents Say They Asked

The suit names Mission Hospital, which it accuses of negligence, and a pediatrician on the hospital’s staff. It asks for an unspecified amount in damages, according to the Citizen Times.

The timeline starts on Nov. 3, 2023. Silas was brought to Mission Hospital after two days of vomiting, diarrhea, fatigue, a reduced appetite and neck pain, plus a rash that had shown up the day before. He was admitted, treated with broad-spectrum antibiotics and discharged the next day, the suit says.

At home, his condition got worse. His eyes and lips turned red, his hands and feet swelled and the rash did not go away. The lawsuit also says the family was told soon after discharge that a spinal fluid culture from the first stay had come back positive for a possible bacterial infection, but that the result was described as inconclusive and possibly caused by contamination. Staff told them Silas did not need to come back. The parents brought him back anyway.

On Nov. 7, Silas was readmitted with a fever of 101.1 degrees. That is when, the lawsuit says, his parents asked about Kawasaki disease. The suit says the doctor dismissed the idea and declined to order testing to exclude it.

Eighteen Days Between Two Diagnoses

Silas went home on Nov. 9 with a working diagnosis of “torticollis secondary to viral cervical lymphadenopathy,” a stiff neck linked to swollen lymph nodes from a viral illness, per the lawsuit.

On Nov. 27, a different pediatrician diagnosed Kawasaki disease. Treatment began at Mission Hospital in early December. By then, the suit says, Silas already had coronary artery aneurysms on both sides of his heart.

On Dec. 10, he was transferred to Boston Children’s Hospital. The lawsuit describes the cardiologist who took over his care there as a leading national expert on Kawasaki disease in children. Tests in Boston confirmed a giant aneurysm in his left coronary artery, according to the suit.

What Kawasaki Disease Does and Why Timing Matters

Kawasaki disease is an inflammation of blood vessels that mostly affects children under 5. UC Davis Health says it typically starts with a fever of 100.4 degrees or higher lasting at least five days, along with some of these signs: bloodshot eyes, a swollen lymph node on one side of the neck, red cracked lips and a strawberry-colored tongue, a rash on the trunk, and swollen red hands and feet.

There is no single test for it. The American Heart Association’s 2024 scientific statement, posted by the Kawasaki Disease Foundation, calls it a clinical diagnosis, meaning doctors rely on the pattern of symptoms after ruling out other illnesses. The statement says that without treatment, about 25% of patients develop dilated or aneurysmal coronary arteries, and that treatment within 10 days of fever onset is strongly linked to a lower risk of those changes.

Standard treatment is an infusion of intravenous immune globulin, known as IVIG, along with aspirin. Stanford Medicine Children’s Health says IVIG relieves the acute inflammation and may lower the chance of coronary artery aneurysms, and that heart ultrasounds, called echocardiograms, are used to watch the arteries.

By the lawsuit’s account, Kawasaki disease was not diagnosed until Nov. 27, 24 days after Silas first arrived at Mission Hospital. The suit says that delay caused the damage to his coronary arteries.

What Lifelong Heart Monitoring Looks Like

The lawsuit says doctors classify Silas as risk level 5.4 for Kawasaki disease, on a scale where level 5 is the highest-risk category. The suit says that group covers roughly 1% of patients and carries the highest rate of long-term problems, including narrowing of the coronary arteries and blood clots.

Because of that, the filing says, Silas will need regular heart monitoring for the rest of his life, including advanced imaging and stress testing, with especially close care through adolescence and possibly beyond.

That fits what heart specialists describe for children with large aneurysms. The 2024 American Heart Association statement says large or giant aneurysms call for blood-thinning medicine, periodic stress testing and surveillance imaging such as coronary CT scans. Brigham and Women’s Hospital’s health library adds that children with an aneurysm may need echocardiograms for several years, and that every follow-up visit matters even when a child feels fine.

What Happens Next in Buncombe County

The Citizen Times reported that HCA Healthcare, which owns Mission Hospital, did not provide a statement by press time. The Alvarados did not respond to the paper’s call. No response from the hospital or the pediatrician named in the suit has been published.

The filing is the start of the legal process, not a ruling. Hospitals and doctors named in negligence suits have the chance to respond in court, and the claims about what was said and not ordered in November 2023 will have to be proved there.

UC Davis Health lists the signs a parent can describe to a doctor: a fever of five days or more, red eyes, a rash, swollen hands and feet and cracked lips. Another family covered on this site noticed something about a newborn’s eyes that hospital staff and a pediatrician had not caught.

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This article was produced with AI assistance and edited for accuracy against the sources linked above.

Image: DiscoA340 – CC BY-SA 4.0/Wikimedia Commons