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Erythema Nodosum Masking Kawasaki Disease with an Initial Manifestation of Skin Lesions
Seigo Okada,Yuichi Ishikawa,Maiko Shimomura,Shinpei Sunagawa,Reiji Hirano,Shinnosuke Fukunaga,Akiko Miyake,Yusuke Okada,Takashi Maki 연세대학교의과대학 2019 Yonsei medical journal Vol.60 No.3
We report the first case demonstrating an association between Kawasaki disease (KD) and erythema nodosum (EN). A 3-year-oldgirl 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 severepain in the neck and cutaneous lesions. Initially, the development of EN was attributed to Salmonella spp infection, which wasdetected in stool culture. However, the patient did not respond to high-dose ampicillin/sulbactam to which the Salmonella spp issensitive. Echocardiography performed as screening for fever of unknown origin revealed medium-sized aneurysms of the leftanterior descending artery. EN masked the diagnosis of KD, and the patient developed a coronary artery lesion. KD should beconsidered in the differential diagnosis of refractory EN in pediatric patients.