Tseng Han-Chi, Ho Ji-Chen, Guo Mindy Ming-Huey, Lo Mao-Hung, Hsieh Kai-Sheng, Tsai Wen-Chien, Kuo Ho-Chang, Lee Chih-Hung
Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
J Dermatol. 2016 Sep;43(9):1044-50. doi: 10.1111/1346-8138.13315. Epub 2016 Mar 3.
For the past decades, although the rash at the bacillus Calmette-Guérin (BCG) inoculation site has been recognized as a diagnostic clue in Kawasaki disease, the present study is the first known one attempting to characterize BCG inoculation by dermatoscopy in Kawasaki disease and correlate the grade of BCG reaction with systemic involvement. Thirty-four patients diagnosed with Kawasaki disease by pediatric specialists were enrolled. We performed detailed history taking, laboratory examination, physical examination and dermatoscopy examinations. Based on the BCG reaction pattern by dermatoscopy, we were able to characterize three patterns: (A) Bull's eye pattern in 18 patients; (B) faint homogenous erythema in nine; and (C) central white patch in seven. Patients from group A exhibited the highest elevation of blood aspartate aminotransferase levels (P < 0.05). Notably, three patients from group A had a significantly dilated coronary artery despite i.v. immunoglobulin injection. We concluded that the bull's eye dermatoscopy sign is not only a useful diagnostic clue but also a severity biomarker in patients with Kawasaki disease.
在过去几十年里，尽管卡介苗（BCG）接种部位的皮疹已被视为川崎病的诊断线索，但本研究是已知的第一项试图通过皮肤镜检查对川崎病患者的卡介苗接种情况进行特征描述，并将卡介苗反应程度与全身受累情况相关联的研究。本研究纳入了34名由儿科专家诊断为川崎病的患者。我们进行了详细的病史采集、实验室检查、体格检查和皮肤镜检查。根据皮肤镜检查的卡介苗反应模式，我们能够确定三种模式：（A）18例患者出现靶心模式；（B）9例患者出现淡红色均匀红斑；（C）7例患者出现中央白色斑块。A组患者的血液天冬氨酸转氨酶水平升高最为明显（P < 0.05）。值得注意的是，A组中有3例患者尽管接受了静脉注射免疫球蛋白治疗，但仍出现了明显的冠状动脉扩张。我们得出结论，靶心皮肤镜征象不仅是川崎病患者有用的诊断线索，也是病情严重程度的生物标志物。
