Incomplete Kawasaki disease with recurrent skin peeling: a case report with the review of literature

Kawasaki disease: characteristics, diagnosis, and unusual presentations

Introduction: Kawasaki disease (KD) is one of the commonest pediatric vasculitides and is associated with a significant risk of development of coronary artery abnormalities if left untreated. Areas covered: In this review, we have highlighted the incomplete and unusual presentations of KD and also emphasize the controversies pertaining to 2D echocardiography in KD. A PubMed search was performed regarding diagnosis and unusual presentations of KD. Expert opinion: Diagnosis of KD is essentially clinical and based on recognition of typical clinical features that may appear sequentially and all signs and symptoms may not be present at one point of time. There is no confirmatory laboratory test for diagnosis of this condition. Further complicating the picture is the fact that incomplete and atypical forms KD may be seen in up to 50% patients. Although 2D echocardiography continues to be the preferred imaging modality for cardiac assessment in patients with KD, it has its limitations.

Atypical desquamation in a 2.5-year-old boy with Kawasaki disease: A case report

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.

Severe desquamation in Kawasaki disease: Is it somehow protective?

Kawasaki disease is a common vasculitis that typically affects children between one and five years of age. We report a 12-year-old boy who presented following a presumed diagnosis of pharyngitis associated with nondesquamating skin rash and conjunctivitis. Despite treatment with amoxicillin for seven days his fever persisted for ten days and then remitted. Two weeks later, he developed full thickness extensive desquamation of his palms and soles that mandated a visit to emergency department in our tertiary health centre. Physical examination revealed full thickness desquamation of his palms and soles with absence of erythema or swelling and he had unremarkable systemic examination. Laboratory tests showed thrombocytosis and high erythrocytes sedimentation rate. Throat culture and Anti-streptolysin-O titer were negative. Aspirin, anti-platelets dose, was initiated. Echocardiography was performed in the first visit and repeated three times later: at four weeks, six weeks and at three months of the illness revealing normal coronary arteries. Follow up complete blood count and sedimentation rate were normal after six weeks, therefore, aspirin was discontinued. Full thickness desquamation, not as it would be expected, might be somehow protective against the involvement of coronary arteries in Kawasaki disease.

Recurrent lip swelling as a late presentation of Kawasaki disease: Case report and review of literature

Kawasaki Disease (KD) is an acute systemic vasculitis of unknown etiology. In many developed countries, KD has replaced rheumatic heart disease as the leading cause of acquired heart disease in children. Among the classical criteria for a diagnosis of KD are oral manifestations such as strawberry tongue, erythematous cracked lip, and oropharyngeal mucositis. We report the case of a 24-year-old Saudi female with a history of Kawasaki disease who presented to our oral medicine clinic with recurrent painless swelling of the upper lip. As lip swelling has not previously been reported as an oral manifestation of KD, this case represents a novel presentation of recurrent Kawasaki disease in an adult female.