Erythema Nodosum Masking Kawasaki Disease with an Initial Manifestation of Skin Lesions
10.3349/ymj.2019.60.3.312
- Author:
Seigo OKADA
1
;
Yuichi ISHIKAWA
;
Maiko SHIMOMURA
;
Shinpei SUNAGAWA
;
Reiji HIRANO
;
Shinnosuke FUKUNAGA
;
Akiko MIYAKE
;
Yusuke OKADA
;
Takashi MAKI
Author Information
1. Department of Pediatrics, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan. sokada0901@gmail.com
- Publication Type:Case Report
- Keywords:
Bacterial infections;
exanthema;
inflammatory disorders;
subcutaneous tissue
- MeSH:
Aneurysm;
Arteries;
Bacterial Infections;
Child, Preschool;
Coronary Vessels;
Diagnosis;
Diagnosis, Differential;
Echocardiography;
Erythema Nodosum;
Erythema;
Exanthema;
Female;
Fever;
Fever of Unknown Origin;
Humans;
Lower Extremity;
Lymphatic Diseases;
Masks;
Mass Screening;
Mucocutaneous Lymph Node Syndrome;
Neck;
Oropharynx;
Salmonella;
Skin;
Subcutaneous Tissue
- From:Yonsei Medical Journal
2019;60(3):312-314
- CountryRepublic of Korea
- Language:English
-
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℃, 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.
