Erythema multiforme as first sign of incomplete Kawasaki disease

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.

Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics

“…Parainfectious exanthema in childhood is often misinterpreted as a cutaneous drug reaction. Kawasaki syndrome, a rare but potentially life-threatening differential diagnosis, particularly in infants and young children, also needs to be considered [26][27][28].…”

“…However, no DPT should be performed if the delayed reaction is severe. tremely rare but potentially life-threatening Kawasaki syndrome, represent important differential diagnoses to BLA-related exanthema [27,28,146]. Furthermore, it is not uncommon for children taking BLA to develop uncomplicated MPE, also referred to as benign rashes.…”

S2k-Leitlinie: Diagnostik bei Verdacht auf eine Betalaktamantibiotika-Überempfindlichkeit

“…Zeitliche Einteilung: Von einer Sofortreaktion wird in der nationalen beziehungsweise internationalen Literatur ausgegangen, wenn eine Reaktion innerhalb von 60 Minuten [19] beziehungsweise innerhalb von sechs Stunden [20] [26,27,28].…”

“…Die kutane Diagnostik, speziell der Intrakutantest wird aufgrund seiner Schmerzha igkeit jedoch gerade im Säuglings-und Kleinkindalter schlechter toleriert als bei Schulkindern, Jugendlichen und Erwachsenen. Zudem stellen andere mit Exanthemen einhergehende Erkrankungen, von häu gen bakteriellen und viralen Infektionserkrankungen bis hin zu dem sehr seltenen aber potenziell lebensbedrohlichen Kawasaki-Syndrom, wesentliche Di erenzialdiagnosen zum BLA-assoziierten Exanthem dar [27,28,145]. Zusätzlich entwickeln Kinder unter Einnahme von BLA nicht selten unkomplizierte MPE, die auch als "benign rashes" bezeichnet werden.…”

Severe Skin Lesions or Arthritis May be Associated with Coronary Artery Lesions in Kawasaki Disease

“…In KD, skin rash usually appears 3-5 days after fever onset and presents as multiple symmetric, erythematous, 16,17) . Whereas, KD patients with severe scattered crusting skin lesions or papules and keratotic lesions were correlated with CALs and refractory clinical course 18) .…”