Atypical desquamation in a 2.5-year-old boy with Kawasaki disease
A case report
Keywords:
Kawasaki disease, Cervical lymphadenopathy, DesquamationAbstract
Kawasaki disease (KD) is a vasculitis that mostly affects children under 5 years of age. This article presents a 2.5-year-old boy who presented with 6 days of fever, generalized maculopapular rash, bilateral non-exudative conjunctivitis, cracked lips, right cervical lymphadenopathy, erythematous extremities, and perianal desquamation. Laboratory studies showed leukocytosis and sterile pyuria. Because diagnosis of KD was proved, oral acetylsalicylic acid with the anti-inflammatory dose and intravenous immunoglobulin were started for him. On the seventh day of admission time, he developed desquamation and erythema on the site of his right cervical lymphadenopathy as well as periungual scaling. About three weeks after starting the treatment, scaling of the cervical lymphadenopathy and periungual area stopped. Echocardiography was performed for him three times: at the time of diagnosis, four weeks, and 6 months later and revealed normal coronary arteries. We report this sign, desquamation on the site of cervical lymphadenopathy, as a new finding.
References
Kawasaki T, Naoe S. History of Kawasaki disease. Clin Exp Nephrol. 2014; 18(2): 301-4. doi:
1007/s10157-013-0877-6. PMID: 24595558.
Mortazavi HR, Amin R, Alyasin S, Kashef S, Karimi MH, Babaei M, et al. Down-regulation of TLR2, 3, 9
and Signaling Mediators, MyD88 and TRIF, Gene Transcript Levels in Patients with Kawasaki Disease
Treated with IVIG. Iran J Allergy Asthma Immunol. 2015; 14(2): 188-97.
Ajami G, Aflaki K, Alyasin S, Gharesi-Fard B, Borzouee M, Amoozgar H. Distribution and Protective
Role of HLAB40 in Iranian Patients with Kawasaki Disease; a Report from Southern Iran. Iran J Pediatr.
; 24(4): 359-64. PMID: 25755855, PMCID: PMC4339557.
Rasouli M, Heidari B, Kalani M. Downregulation of Th17 cells and the related cytokines with treatment in
Kawasaki disease. Immunol Lett. 2014; 162(1): 269-75. doi: 10.1016/j.imlet.2014.09.017. PMID:
Heidari B, Amin R, Kashef S, Alyasin S, Moghtaderi M, Aminshahidi M, et al. Expression of CD11b as an
Adhesion Molecule on Neutrophils in Children with Kawasaki Disease. Iran J Allergy Asthma Immunol.
; 13(4): 265-70. PMID: 24659162.
Sánchez-Manubens J, Bou R, Anton J. Diagnosis and classification of Kawasaki disease. J Autoimmun.
; 48-49: 113-7. doi: 10.1016/j.jaut.2014.01.010. PMID: 24485156.
Greco A, De Virgilio A, Rizzo MI, Tombolini M, Gallo A, Fusconi M, et al. Kawasaki disease: An
evolving paradigm. Autoimmun Rev. 2015; 14(8): 703-9. doi: 10.1016/j.autrev.2015.04.002. PMID:
Kitano N, Suzuki H, Takeuchi T, Suenaga T, Kakimoto N, Shibuta S, et al. Epidemiologic features and
prognostic factors of coronary artery lesions associated with Kawasaki disease based on a 13-year cohort of
consecutive cases identified by complete enumeration surveys in Wakayama, Japan. J Epidemiol. 2014;
(5): 427-34. doi: 10.2188/jea.JE20140018. PMID: 24998951, PMCID: PMC4150015.
Dimitriades VR, Brown AG, Gedalia A. Kawasaki disease: pathophysiology, clinical manifestations, and
management. Curr Rheumatol Rep. 2014; 16(6): 423. doi: 10.1007/s11926-014-0423-x. PMID: 24744086.
Saguil A, Fargo M, Grogan S. Diagnosis and management of kawasaki disease. Am Fam Physician. 2015;
(6): 365-71. PMID: 25822554.
Lipsker D. Clinical Examination and Differential Diagnosis of Skin Lesions. Springer. 2013; 215-7. doi:
1007/978-2-8178-0411-8-41.
Drago F, Javor S, Ciccarese G, Cozzani E, Parodi A. Complete Kawasaki Disease in a 21-Year-Old
Caucasian Patient. Case Reports in Clinical Medicine. Sci Res. 2015; 4(5): 175. doi:
4236/crcm.2015.45035.
Parmar RC, Somale A, Bavdekar SB, Muranjan MN. Incomplete Kawasaki disease with recurrent skin
peeling: a case report with the review of literature. J Postgrad Med. 2003; 49(1): 72-4. doi: 10.4103/0022- 3859.924. PMID: 12865575.
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