An ulcerated lesion at the BCG vaccination site during the course of Kawasaki disease

Kuniyuki, Shuichi; Asada, Minoru

doi:10.1016/s0190-9622(97)80376-3

Cited by 59 publications

(25 citation statements)

References 12 publications

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“…The characteristic features of the BCG site in KD were reported to be due to the T-cell-mediated delayed hypersensitive reaction rather than to the deterioration of tuberous infection (Sato et al 1993;Kuniyuki and Asada 1997). The evidence for the T-cell system activation in our patient was an elevation in the serum sIL2R level, which has also been reported in KD (Lang et al 1990).…”

Section: Discussionsupporting

confidence: 78%

Human Herpes Virus Type 6 Can Cause Skin Lesions at the BCG Inoculation Site Similar to Kawasaki Disease

Kakisaka

Ohara

Katayama

et al. 2012

Tohoku J. Exp. Med.

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Kawasaki Disease (KD) is acute, febrile, multisystem vasculitis of early childhood, the detailed mechanism of which is still unclear. Skin symptoms occur in KD, such as edema of the hands and feet with subsequent desquamation and redness at the inoculation site of bacillus Calmette-Guerin (BCG). The change at the BCG inoculation site has been considered as a specific feature of KD, although its mechanism is not fully understood. We present an 11-month-old boy who developed fever with redness of the BCG site due to infection with human herpes virus type 6 (HHV6). At the age of 3 months, the patient received BCG. His fever remitted 7 days after the onset of skin redness, with sequential desquamation at the BCG site and extremities, which is not a common feature of HHV6 infection that typically lasts for 3 days. The final diagnosis was exanthema subitum. Characteristically, the HHV6 infection in our patient appeared to be associated with the invigoration of the T cell system, as represented by the elevated serum levels of soluble interleukin-2 receptor (3,490 U/ml vs. normal range 145-519 U/ml). This patient clearly showed redness and crusting at the BCG inoculation site, suggesting that HHV6 infection might cause skin changes similar to those of KD via an unknown mechanism. In addition, we suggest that the activation of the T cell system may account for the skin lesions in KD, characterized by redness and subsequent crusting of the BCG inoculation site and desquamation of the extremities. Kawasaki disease (KD) is acute, febrile, multisystem vasculitis of early childhood, the detailed mechanism of which is still unclear. Skin symptoms occur in KD, including polymorphous rash, edema of the hands and feet with subsequent desquamation, and redness and desquamation of the bacillus Calmette-Guerin (BCG) inoculation site. The skin lesions at the BCG inoculation site were reported to be a specific feature of KD, although its mechanism is not fully understood (Sinha and Balakumar 2005;Weinstein 2006).Here, we report a patient with redness of the BCG site with subsequent crusting of the site and desquamation of the extremities in the recovery phase and who was proven serologically to have infection with human herpes virus type 6 (HHV6). Clinical FindingsAn 11-month-year-old boy developed fever of 38-40°C, without symptoms suggesting an infection focus.His medical and family histories were unremarkable. He received a BCG inoculation at the age of 3 months. There was no cough or throat redness, and was only a non-specific rash. He was referred to our hospital at day 4 because of persistent fever and poor general condition. He was not active in eating. On admission to our hospital, he showed redness at the BCG inoculation site (Fig. 1a), which is regarded as specific to KD (Weinstein 2006). However, his clinical features were far from those of typical KD. There was no non-exudative conjunctivitis, oral findings, extremity changes, or obvious cervical lymphadenopathy. The peripheral blood cell examination showed white blood cel...

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Section: Discussionsupporting

confidence: 78%

Human Herpes Virus Type 6 Can Cause Skin Lesions at the BCG Inoculation Site Similar to Kawasaki Disease

Kakisaka

Ohara

Katayama

et al. 2012

Tohoku J. Exp. Med.

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“…60 Erythema and induration at the site of a previous vaccination with Bacille Calmette-Guérin (BCG) is common in Japan, where BCG is used widely. 66 Rare findings include testicular swelling, pulmonary nodules 50 and infiltrates, 67 pleural effusions, and hemophagocytic syndrome. 68 …”

Section: Noncardiac Findingsmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease

Newburger¹,

Takahashi²,

Gerber³

et al. 2004

Circulation

1,613

818

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Background— Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in ∼15% to 25% of untreated children and may lead to ischemic heart disease or sudden death. Methods and Results— A multidisciplinary committee of experts was convened to revise the American Heart Association recommendations for diagnosis, treatment, and long-term management of Kawasaki disease. The writing group proposes a new algorithm to aid clinicians in deciding which children with fever for ≥5 days and ≤4 classic criteria should undergo echocardiography, receive intravenous gamma globulin (IVIG) treatment, or both for Kawasaki disease. The writing group reviews the available data regarding the initial treatment for children with acute Kawasaki disease, as well for those who have persistent or recrudescent fever despite initial therapy with IVIG, including IVIG retreatment and treatment with corticosteroids, tumor necrosis factor-α antagonists, and abciximab. Long-term management of patients with Kawasaki disease is tailored to the degree of coronary involvement; recommendations regarding antiplatelet and anticoagulant therapy, physical activity, follow-up assessment, and the appropriate diagnostic procedures to evaluate cardiac disease are classified according to risk strata. Conclusions— Recommendations for the initial evaluation, treatment in the acute phase, and long-term management of patients with Kawasaki disease are intended to assist physicians in understanding the range of acceptable approaches for caring for patients with Kawasaki disease. The ultimate decisions for case management must be made by physicians in light of the particular conditions presented by individual patients.

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“…34 -36) These changes are marked in scars of BCG vaccination, and granulomatous inflammation was noted in some cases. 37) Endothelial cells enlarged and were surrounded by infiltrating monocytes/macrophages and CD4-positive T cells, but very few neutrophils and B cells were present. No panangiitis was noted.…”

Section: Skinmentioning

confidence: 99%

Kawasaki Disease as a Systemic Vasculitis in Childhood

Takahashi

Oharaseki

Yokouchi

et al. 2010

Annals of Vascular Diseases

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Kawasaki disease is a disease of unknown etiology that most frequently affects infants and children under 5 years of age. Inflammation occurs in medium-sized muscular arteries throughout the body including the coronary artery, being classified as a systemic vasculitis syndrome. Histopathological investigations of Kawasaki disease have mainly focused on the coronary artery because it is directly associated with the cause of death. However, to identify the cause and pathology of Kawasaki disease, it is necessary to investigate lesions of whole organs. Thus, we attempted to review lesions in organs other than the heart and hypotheses of pathogenesis recently attracting attention.

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An ulcerated lesion at the BCG vaccination site during the course of Kawasaki disease

Cited by 59 publications

References 12 publications

Human Herpes Virus Type 6 Can Cause Skin Lesions at the BCG Inoculation Site Similar to Kawasaki Disease

Human Herpes Virus Type 6 Can Cause Skin Lesions at the BCG Inoculation Site Similar to Kawasaki Disease

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease

Kawasaki Disease as a Systemic Vasculitis in Childhood

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