The Perineal Eruption of Kawasaki Syndrome

Friter, Barry S.; Lucky, Anne W.

doi:10.1001/archderm.1988.01670120021004

Cited by 64 publications

(15 citation statements)

References 31 publications

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“…All piglets that received HS infusion in our study developed varying degrees of exanthemas, starting mostly from the perineal regions, then spreading to the trunk, legs, ear, and mouth. The appearance and spreading of the rashes that we observed were somewhat similar to those of KD described by Fritter et al (35). Indurative edema and peeling of the skin were not observed in our study.…”

Section: Discussionsupporting

confidence: 91%

A Swine Model of Horse Serum-Induced Coronary Vasculitis: An Implication for Kawasaki Disease

et al. 2004

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An attempt was made to induce immune complex vasculitis by horse serum (HS) infusions in piglets, hoping to produce experimental coronary artery lesions that mimic Kawasaki disease. A total of 21 purebred male piglets of 1.5, 2.5, and 3 mo were divided into HS (n ϭ 14) and control, normal saline (NS; n ϭ 7) groups. In seven piglets, 5 mL/kg of HS was infused, then repeated with 10 mL/kg 10 d later. In another seven piglets, 10 mL/kg of HS was infused three times at 5-d intervals. In three piglets in the control group, 5 and 10 mL/kg of NS was infused at 10-d intervals. In another four piglets of the control group, 10 mL/kg of NS was infused three times at 5-d intervals. Twodimensional echocardiographic examinations for visualization and measurement of the coronary arteries were done before and after infusions at 4-to 5-d interval. Hematology examination showed that white blood cells and platelets decreased, then increased. The animals were killed at 14 -60 d after the first infusion of HS or NS, for histopathologic and immunohistochemical studies. All HS groups developed skin rashes and echocardiographic evidence of coronary artery dilation and histopathologic changes of vasculitis. None in the NS group developed vasculitis. The main changes of the coronary vasculitis were intimal proliferation, smooth muscle cell necrosis, and vacuolization changes. Those that received three HS infusions developed more skin rashes than those that received two infusions. It is concluded that piglets may serve as an experimental model for immune complex vasculitis involving the coronary arteries with skin rashes mimicking Kawasaki disease. Kawasaki disease (KD), an acute self-limiting systemic vasculitis of unknown origin, has become a leading cause of acquired heart disease other than rheumatic heart disease in many developed countries (1-3). Coronary artery lesions (CALs) with aneurysmal dilation, thrombosis, and/or stenosis, leading to myocardial infarction and death, have been recognized as the most severe complication (4, 5). Circulating immune complexes (ICs), triggered by infectious agents, bacteria, or viral or other unknown cause, have been detected in the early phase of KD, implicating that immunopathologic mechanisms might be involved in the pathogenesis of vasculitis in KD (6 -10). Attempts to produce coronary vasculitis have been made in mice, weanling rabbits, and guinea pigs by injecting infectious agents, foreign proteins, and Lactobacillus casei cell walls (11-15). Coronary arteritis was induced in weanling rabbits by injecting horse serum (HS) (16). Swine is a unique and promising animal for biomedical research, especially in the field of cardiovascular diseases (17, 18). IC coronary vasculitis, however, was never produced in swine. We tried, therefore, to induce coronary vasculitis in piglets, hoping that CAL mimicking KD could be produced. This study was designed to observe the skin and systemic reactions and hematologic changes, measure the coronary artery diameters by echocardiography, and examine the histop...

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Section: Discussionsupporting

confidence: 91%

A Swine Model of Horse Serum-Induced Coronary Vasculitis: An Implication for Kawasaki Disease

et al. 2004

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“…In some of these cases, the diagnosis was made only when a coronary artery aneurysm had been diagnosed, but it should be noted that in all of them, high fever lasting at least 5 days was present, and recurrence of the cutaneous rash was not observed at the follow-up examination. 7 On the contrary, all of our patients were in good health when the cutaneous eruption started, suggesting the presence of a very benign disease. Moreover, findings from laboratory and instrumental tests were also normal or negative except for the presence of a group A ␤-hemolytic streptococcus isolated from the throat or cutaneous culture.…”

Section: Commentmentioning

confidence: 56%

“…1 However, in children this cutaneous picture has been mainly reported in conditions with different prognosis such as Kawasaki syndrome (KS) in children and RTPE in young adults. 3,7,8 While RTPE is a benign self-limiting mucocutaneous disorder mediated by superantigens, KS is an acute multisystemic illness, being the most common cause of acquired heart disease (25% of untreated children). 9,10 In the past decades, the hypothesis that KS is also a toxinmediated staphylococcal or streptococcal disease has been proposed because some of the major diagnostic criteria of KS (fever of at least 5 days' duration plus at least 4 of the 5 following 5 conditions: peripheral extremity changes [eg, edema, erythema, and desquamation], polymorphous exanthem, changes of lips and oral cavity [eg, erythema and strawberry tongue], acute nonpurulent cervical lymphadenopathy, and/or conjunctival injection) are characteristic of other toxin-mediated diseases.…”

Section: Commentmentioning

confidence: 99%

Recurrent Toxin-Mediated Perineal Erythema

Patrizi¹,

Raone²,

Savoia³

et al. 2008

Arch Dermatol

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Background: Recurrent toxin-mediated perineal erythema is a cutaneous disease mediated by superantigens made by staphylococci and streptococci, which, to our knowledge, has only been reported in young adults. We describe recurrent toxin-mediated perineal erythema in 11 children and outline the differences between recurrent toxin-mediated perineal erythema and Kawasaki disease in this age range.Observations: Eleven children (7 male and 4 female) presented with the sudden appearance of asymptomatic erythema, which was salmonlike in color and rapidly desquamating, involving the perineum in 10 patients and extending to the perianal area in 1 patient. At the onset of the rash, all patients were in good health, although 9 had mild fever for 1 to 2 days before its appearance. Physical examination also revealed an erythema of the hands and feet in 4 patients and strawberry tongue in 7. Two patients had a facial impetigo, and another showed a perianal streptococcal dermatitis. A group A ␤-hemolytic streptococcus was isolated from the throat in 10 cases and from a perianal culture in 1 case. In 8 cases, resolution was spontaneous, but all patients were treated with systemic antimicrobial therapy for 10 days. Three patients had a personal history of cutaneous rashes on the perineal area during the last years before consultation. Rash recurrence was observed in 3 of the 11 patients at the follow-up examination. Conclusion:Recurrent toxin-mediated perineal erythema can be observed not only in young adults but also in childhood

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“…Nedeni açıklanamayan, beş günden daha uzun süren yüksek ateş varlığında KH düşünülmeli ve tanı kriterleri açısından değerlendirilmelidir. Perineal eritem tanı kriterleri arasında yer almasa da, akut Kawasaki hastalığı bulunan 58 yenidoğan veya çocuk hastanın %67'sinde saptanmıştır 3,8 . Toksinlerle oluşan rekürren perineal eritem, Kawasaki hastalığından farklı olarak kendini sınırlayan benin bir durumdur.…”

Section: Discussionunclassified

Toksinlerle oluşan rekürren perineal eritem: Olgu sunumu ve literatür değerlendirmesi

Aytekin¹

2013

TURKDERM

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ÖzetToksinlerle oluşan rekürren perineal eritem (TORPE), stafilokok ve streptokok süperantijenleriyle oluşan, kendiliğinden iyileşen bir hastalıktır. İnguinal bölge, perine veya alt abdomende yerleşen, genellikle asemptomatik, iyi sınırlı deskuamatif eritemle karakterizedir. Hastalığın diğer tipik özellikleri ise akral ödem, çilek dil ve mukozittir. TORPE, antibiyotik tedavisini izleyen günlerde hızla iyileşir. Burada 10 yaşında, çilek dil ve rekürren deskuamatif perineal eritem bulunan TORPE'li bir olgu sunulmaktadır. Ayrıca toksinle oluşan ve/veya perineal eritem bulunan hastalıklar literatürde değerlendirilmiştir. Ekzantemli pediyatrik hastalar genellikle aile hekimleri veya pediatristler, nadiren de dermatologlar tarafından değerlendirilir. Biz bu olguyla dermatologların dikkatini çekmek istedik. Sum maryRecurrent toxin-mediated perineal erythema (RTPE) is a benin self-limiting mucocutaneous disorder caused by super antigens produced by staphylococci and streptococci. It is characterized by generally asymptomatic well-demarcated desquamating erythema involving the perineum, groin or lower abdomen. Other typical features such as acral edema, strawberry tongue and mucositis are often present. RTPE rapidly improves after antibiotic therapy. Herein, we report a 10-year-old boy with RTPE who presented with strawberry tongue and recurrent desquamating perineal erythema. We also reviewed the literature on diseases that are toxin mediated and/or presenting with perineal erythema. Pediatric patients with exanthema are primarily seen by pediatricians or family physicians, and rarely by dermatologists. With this report, we wish to draw the attention of dermatologists. (Turkderm 2013; 47: 236-8)

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The Perineal Eruption of Kawasaki Syndrome

Cited by 64 publications

References 31 publications

A Swine Model of Horse Serum-Induced Coronary Vasculitis: An Implication for Kawasaki Disease

A Swine Model of Horse Serum-Induced Coronary Vasculitis: An Implication for Kawasaki Disease

Recurrent Toxin-Mediated Perineal Erythema

Toksinlerle oluşan rekürren perineal eritem: Olgu sunumu ve literatür değerlendirmesi

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