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Saez-de-Ocariz M, Gámez-González LB, Rivas-Larrauri F, Castaño-Jaramillo LM, Toledo-Salinas C, Garrido-García LM, Ulloa-Gutierrez R, Santamaría-Piedra M, Orozco-Covarrubias MDLL, Scheffler-Mendoza S, Yamazaki-Nakashimada MA. Kawasaki disease mimickers. Pediatr Int 2021; 63:880-888. [PMID: 33249696 DOI: 10.1111/ped.14561] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/14/2020] [Accepted: 11/18/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Kawasaki disease (KD) is an acute systemic vasculitis that predominantly affects patients younger than 5 years. In the absence of an available, affordable diagnostic test, detailed clinical history and physical examination are still fundamental to make a diagnosis. METHODS We present five representative cases with KD-like presentations: systemic onset juvenile idiopathic arthritis, mycoplasma-induced rash and mucositis, staphylococcal scalded skin syndrome, BCGosis, and the recently described multisystemic inflammatory syndrome in children (MIS-C) associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) virus. RESULTS Rash, fever, and laboratory markers of inflammation can be present in several childhood diseases that may mimic KD. CONCLUSION The term 'Kawasaki syndrome' instead of 'Kawasaki disease' may be more appropriate. Physicians should consider an alternative diagnosis that may mimic KD, particularly considering MIS-C during the present pandemic, as an aggressive diagnostic and therapeutic approach is needed.
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Affiliation(s)
| | | | | | | | - Carla Toledo-Salinas
- Clinical Immunology Department, Instituto Nacional de Pediatría, Mexico City, Mexico
| | | | - Rolando Ulloa-Gutierrez
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños "Dr. Carlos Sáez Herrera", San José, Costa Rica
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Affiliation(s)
- Samantha Shwe
- Department of Dermatology, University of California, Irvine, California
| | - Christina N Kraus
- Department of Dermatology, University of California, Irvine, California
| | - Kenneth G Linden
- Department of Dermatology, University of California, Irvine, California
| | - Nathan W Rojek
- Department of Dermatology, University of California, Irvine, California
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Okada S, Ishikawa Y, Shimomura M, Sunagawa S, Hirano R, Fukunaga S, Miyake A, Okada Y, Maki T. Erythema Nodosum Masking Kawasaki Disease with an Initial Manifestation of Skin Lesions. Yonsei Med J 2019; 60:312-314. [PMID: 30799595 PMCID: PMC6391528 DOI: 10.3349/ymj.2019.60.3.312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/06/2019] [Accepted: 01/17/2019] [Indexed: 11/27/2022] Open
Abstract
We report the first case demonstrating an association between Kawasaki disease (KD) and erythema nodosum (EN). A 3-year-old girl presented with EN as an initial manifestation of KD. At the initial visit, she showed high fever of 40°C, injection of the oropharynx, cervical lymphadenopathy, and red-purple cutaneous nodules, particularly on the lower limbs. She complained of severe pain in the neck and cutaneous lesions. Initially, the development of EN was attributed to Salmonella spp infection, which was detected in stool culture. However, the patient did not respond to high-dose ampicillin/sulbactam to which the Salmonella spp is sensitive. Echocardiography performed as screening for fever of unknown origin revealed medium-sized aneurysms of the left anterior descending artery. EN masked the diagnosis of KD, and the patient developed a coronary artery lesion. KD should be considered in the differential diagnosis of refractory EN in pediatric patients.
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Affiliation(s)
- Seigo Okada
- Department of Pediatrics, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan.
| | - Yuichi Ishikawa
- Department of Pediatrics, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
| | - Maiko Shimomura
- Department of Pediatrics, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Shinpei Sunagawa
- Department of Pediatrics, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
- Sunagawa Children's Clinic, Onoda, Japan
| | - Reiji Hirano
- Department of Pediatrics, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
| | - Shinnosuke Fukunaga
- Department of Pediatrics, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
| | - Akiko Miyake
- Department of Pediatrics, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
| | - Yusuke Okada
- Department of Pediatrics, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
| | - Takashi Maki
- Department of Pediatrics, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
- Department of Pediatrics, National Hospital Organization Kanmon Medical Center, Shimonoseki, Japan
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Abstract
We have explored the rash that appears as target lesions, with the central and dominant diseases belonging to the Stevens-Johnson syndrome/toxic epidermal necrolysis group. After presenting the clinical patterns of an individual target lesion and classifying them into different types of lesions, the contribution has been organized with groups characterized by such specific findings according to the type of lesion: flat or raised, typical or atypical, presence or absence of fever, presence or absence of mucosal ulcerations, presence or absence of arthralgias, and/or internal organ involvement. Other specific features, such as histologic appearance, immunofluorescence findings, and laboratory changes, are considered. We provide clinicians with an algorithmic, systematic, and logical approach to diagnose the condition of the patients who present with targetoid lesions, and enable them to differentiate between those with serious systemic and life-threatening diseases from others with ordinary skin ailments.
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Affiliation(s)
- Ronni Wolf
- The School of Medicine, Hebrew University, Jerusalem, Israel; Hadassah Medical Center, Jerusalem, Israel.
| | - Jennifer L Parish
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA; Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Lawrence Charles Parish
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Vaughan C, Graves MS, Lesher JL, White C. A Micropustular Rash in a Febrile Child. Pediatr Dermatol 2015; 32:547-8. [PMID: 26184400 DOI: 10.1111/pde.12546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Claire Vaughan
- Georgia Regents University, Medical College of Georgia, Georgia Regents University, Augusta, Georgia
| | - Michael S Graves
- Section of Dermatology, Medical College of Georgia, Georgia Regents University, Augusta, Georgia
| | - Jack L Lesher
- Section of Dermatology, Medical College of Georgia, Georgia Regents University, Augusta, Georgia
| | - Christopher White
- Department of Pediatrics, Medical College of Georgia, Georgia Regents University, Augusta, Georgia
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Vaccaro M, Crisafulli G, Barbuzza O, Guarneri F, Cannavo SP. Figurate erythema, lymphadenopathy and Fever in a 19 month old child. Diagnosis: Kawasaki disease mimicking a figurate inflammatory dermatosis of infancy. Pediatr Dermatol 2013; 30:491-2. [PMID: 23819450 DOI: 10.1111/j.1525-1470.2012.01836.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Mario Vaccaro
- Institute of Dermatology Department of Pediatrics, University of Messina, Policlinico Universitario, Messina, Italy.
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Vierucci F, Tuoni C, Moscuzza F, Saggese G, Consolini R. Erythema multiforme as first sign of incomplete Kawasaki disease. Ital J Pediatr 2013; 39:11. [PMID: 23406772 PMCID: PMC3632492 DOI: 10.1186/1824-7288-39-11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 01/09/2013] [Indexed: 12/18/2022] Open
Abstract
Incomplete Kawasaki disease represents a diagnostic challenge for pediatricians. In the absence of classical presentation, the laboratoristic evaluation of systemic inflammation can help in placing the correct diagnosis to promptly start adequate therapy. Erythema multiforme is an acute, self-limiting condition considered to be a hypersensitivity reaction commonly associated with various infections or medications. This aspecific skin condition has been rarely described as a sign of Kawasaki disease. We report on the case of a 4 years old boy presenting high-grade fever associated with erythema multiforme and evidence of systemic inflammation who showed a good response to prompt treatment with intravenous immunoglobulins.
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Affiliation(s)
- Francesco Vierucci
- Pediatric Unit, Maternal & Infant Department, S. Chiara University-Hospital, Via Roma 67, Pisa 56126, Italy.
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Smith SD, Dennington PM, Cooper A. The use of intravenous immunoglobulin for treatment of dermatological conditions in Australia: A review. Australas J Dermatol 2010; 51:227-37. [DOI: 10.1111/j.1440-0960.2009.00578.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kourda M, Bouaziz A, Tougourti MN. [Necrotic lesions of the face in Kawasaki disease]. Arch Pediatr 2010; 17:1667-9. [PMID: 20884182 DOI: 10.1016/j.arcped.2010.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 12/01/2009] [Accepted: 08/12/2010] [Indexed: 10/19/2022]
Abstract
Kawasaki disease (KD) is a multisystemic vasculitis disorder in children. The dermatological manifestations are described as polymorphic and nonspecific. However, they are important for diagnosis. They correspond to 3 out of the 5 major criteria that may be associated with the disease's constant fever. We report the case of a child aged 3 years 8 months who showed necrotic lesions on the cheeks and the nose, associated with an erythematous, macular eruption on the rest of the body. Necrotic lesions have been exceptionally reported. These misleading cutaneous aspects should not delay or rule out the diagnosis of KD, especially in atypical or incomplete forms. Early diagnosis of KD should be made before the onset of coronary lesions.
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Rodgers CJ, Tey HL. An Exanthem with An Annular Pattern in a 2-year-old Girl. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2010. [DOI: 10.47102/annals-acadmedsg.v39n8p662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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