Zvulunov A, Greenberg D, Cagnano E, Einhorn M
Department of Paediatrics, Joseftal Hospital, Beer-Sheva, Israel.
J Paediatr Child Health. 2003 Apr;39(3):229-31. doi: 10.1046/j.1440-1754.2003.00117.x.
A 7-month-old infant developed a discrete pustular rash confined to both soles during the acute phase of Kawasaki disease. Histological examination of a pustular lesion from the sole of a foot showed subcorneal neutrophilic microabscesses, psoriasiform acanthosis with a thin granular layer and mononuclear perivascular infiltrates in the upper dermis, consistent with psoriasis. Following the standard treatment with intravenous gamma globulin, the initial symptoms and signs of Kawasaki disease resolved completely. Eight weeks later, psoriasiform plaques appeared on both cheeks and on the extensor surfaces of the forearms and legs. Skin biopsy from one of these lesions revealed psoriasiform epidermal hyperplasia, focal parakeratosis and dilated papillary capillaries. The patient was treated with mild-potency topical steroids that resulted in rapid and complete resolution of the skin lesions. Concurrent association of psoriatic skin lesions and Kawasaki disease might not be incidental and could stem from a common pathogenetic mechanism induced by superantigens.
一名7个月大的婴儿在川崎病急性期出现了仅局限于双足底的散在脓疱性皮疹。对足底脓疱性病变进行组织学检查显示，角质层下有嗜中性粒细胞微脓肿，呈银屑病样棘层增厚，颗粒层薄，真皮上层有单核细胞血管周围浸润，符合银屑病表现。经静脉注射丙种球蛋白标准治疗后，川崎病的初始症状和体征完全消退。8周后，双颊以及前臂和腿部伸侧出现了银屑病样斑块。对其中一处皮损进行皮肤活检显示，有银屑病样表皮增生、局灶性角化不全和扩张的乳头毛细血管。该患者接受了低效外用类固醇治疗，皮肤病变迅速完全消退。银屑病性皮肤病变与川崎病的并发可能并非偶然，可能源于超抗原诱导的共同致病机制。
