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

Rc, Parmar; Somale, Alpana; Sb, Bavdekar; Mn, Muranjan

doi:10.4103/0022-3859.924

Cited by 17 publications

(15 citation statements)

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“…In this cohort, cases without desquamation were significantly more likely to have coronary aneurysms despite treatment with intravenous immunoglobulin within the first 10 days after the onset of fever [4]. Moreover, Patients suffering from KD may have a single episode of skin desquamation or recurrent episodes [8,9]. Patients who have recurrence of peeling tend to have less peeling over time and they usually don't have significant coronary disease.…”

Section: Discussionmentioning

confidence: 90%

Severe desquamation in Kawasaki disease: Is it somehow protective?

Alqanatish

Babiker

2017

Sudan J Paed

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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.

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Section: Discussionmentioning

confidence: 90%

Severe desquamation in Kawasaki disease: Is it somehow protective?

Alqanatish

Babiker

2017

Sudan J Paed

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“…Intravenous immunoglobulin (IVIG) is the first line of treatment, commonly given in a single dose of 2 g/kg b.m. given over 10-12 hours which is aimed to prevent or reduce aneurysm formation as well as symptomatic relief for acute illness 15 and has been proven beneficial especially if administered in the early phase. High-dose of oral aspirin is then given for its anti-inflammatory effects (80-100 mg/kg b.m.…”

Section: Resultsmentioning

confidence: 99%

Infantile cervical adenopathy and pyrexia with an unexpected sequel

2019

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“…Clinicians should be aware of this condition and make parents aware too following the acute stage of KD or post-streptococcal vasculitis. This harmless skin peeling may occur several times preceded by infections up to 7 years following the resolving of the initial episode [2,3]. It is likely that the recurrence of skin peeling following KD could happen more if it is associated with streptococcal infection and or vitamin D deficiency.…”

Section: Discussionmentioning

confidence: 99%

“…Nail changes can occur in both streptococcal infection and KD, however nail changes were not reported before in the post KD recurrent harmless skin peeling; therefore, this is the first report of such association too. Interestingly group A streptococcal (GAS) is an often association with KD [1], and the exact cause of recurrent skin peeling in KD is not well known and rarely reported [2,3].…”

Section: Introductionmentioning

confidence: 99%

Recurrent Peeling of Skin Following Post-Streptococcal Atypical Kawasaki Disease: A Case Report and Literature Review

Hassan

2019

Int J Clin Pediatr

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Kawasaki disease (KD) is a systemic vasculitis occurring due to collective immune mechanisms in a genetically susceptible individual, triggered by infections, though the actual cause is yet to be determined. KD is the most common cause of coronary heart disease in children. Typical diagnostic criteria are fever more than 4 days plus four of clinical criteria of cervical lymphadenopathy, skin rashes, mucus membrane redness and lip changes, non-purulent conjunctivitis, peripheral changes in palms and feet. In atypical cases three criteria with fever are enough to commence treatment and echocardiograph early. An often-reported association with KD is streptococcal infections. Skin peeling occurs in both conditions, however in streptococcal infections it occurs early while late during convalescence stage in KD except peeling of the genitocrural area that may occurs early. Skin peeling in the streptococcal infection is related to exotoxin while the cause of the peeling in KD is not well known; but it is likely related to the immunological pathogenesis. Another type of skin peeling that occurs recurrently following the initial attack of KD in many months is of an unknown reason. The presentation in this report is exceptional; it is for the first time reporting association of atypical KD presented with post streptococcal complications and vitamin D deficiency followed by the skin re-peeling 6 months after the patients fully resolved. Moreover, it is for the first time reporting nail changes, painful micturition due to urethral involvement and mucus membrane erythema that all resolved without treatment. The cause possibly is related to innate immune mechanism post infections and possible role for vitamin D deficiency paving the way for the post-group A streptococcal (GAS) vasculitis which is an immune response that later acted to trigger the skin peeling. Patient initially presented with significant peeling of streptococcal infections and features of KD responding to monoclonal antibody. This case highlights that clinicians need to know about recurrent peeling following KD in many months and to make the parents aware about its harmless course. It is the first report of association of post streptococcal atypical KD vasculitis, vitamin D deficiency, skin harmless post-KD skin peeling, nail changes, mucus membrane erythema and painful micturition due to urethral involvement.

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

Cited by 17 publications

References 0 publications

Severe desquamation in Kawasaki disease: Is it somehow protective?

Severe desquamation in Kawasaki disease: Is it somehow protective?

Infantile cervical adenopathy and pyrexia with an unexpected sequel

Recurrent Peeling of Skin Following Post-Streptococcal Atypical Kawasaki Disease: A Case Report and Literature Review

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