Children's University Hospital and Institute of Molecular Medicine, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland; ; Division of Infectious Diseases; Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario.
Can J Infect Dis Med Microbiol. 2012 Fall;23(3):137-9. doi: 10.1155/2012/638357.
A three-year-old boy presented with community-acquired pneumonia complicated by empyema. Streptococcus pyogenes (group A streptococcus) was identified on culture of the pleural fluid. The patient improved with antibiotic therapy and drainage of the empyema. During his convalescence, the patient developed persistent fever, lethargy and anorexia. His inflammatory markers were elevated, and repeat cultures were negative. Although the patient had none of the classical mucocutaneous features of Kawasaki disease, an echocardiogram was performed, which revealed coronary artery dilation. The patient was diagnosed with incomplete Kawasaki disease and treated with intravenous immunoglobulin and high-dose acetylsalicylic acid. The fever subsided within 48 h. To the authors' knowledge, the present report is the first report of Kawasaki disease associated with complicated S pyogenes pneumonia. It emphasizes the importance of considering incomplete Kawasaki disease among children with persistent fever, the role of echocardiography in diagnosis, and the potential link between Kawasaki disease and superantigen-producing organisms such as S pyogenes.
一名 3 岁男孩因社区获得性肺炎并发脓胸就诊。胸腔液培养鉴定出化脓链球菌（A 组链球菌）。患者经抗生素治疗和脓胸引流后病情好转。在康复期间，患儿持续发热、嗜睡和食欲不振。其炎症标志物升高，重复培养均为阴性。尽管患儿无川崎病的典型黏膜皮肤特征，但仍进行了超声心动图检查，结果显示冠状动脉扩张。患儿被诊断为不完全川崎病，并接受了静脉注射免疫球蛋白和大剂量乙酰水杨酸治疗。48 小时内体温下降。据作者所知，本报告是首例与化脓性链球菌肺炎并发的川崎病报告。它强调了在持续性发热的儿童中考虑不完全川崎病的重要性，超声心动图在诊断中的作用，以及川崎病与产超抗原的生物体（如化脓性链球菌）之间的潜在联系。
