Okada Seigo, Ishikawa Yuichi, Shimomura Maiko, Sunagawa Shinpei, Hirano Reiji, Fukunaga Shinnosuke, Miyake Akiko, Okada Yusuke, Maki Takashi
Department of Pediatrics, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan.
Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan.
Yonsei Med J. 2019 Mar;60(3):312-314. doi: 10.3349/ymj.2019.60.3.312.
We report the first case demonstrating an association between Kawasaki disease (KD) and erythema nodosum (EN). A 3-year-old girl presented with EN as an initial manifestation of KD. At the initial visit, she showed high fever of 40°C, injection of the oropharynx, cervical lymphadenopathy, and red-purple cutaneous nodules, particularly on the lower limbs. She complained of severe pain in the neck and cutaneous lesions. Initially, the development of EN was attributed to spp infection, which was detected in stool culture. However, the patient did not respond to high-dose ampicillin/sulbactam to which the spp is sensitive. Echocardiography performed as screening for fever of unknown origin revealed medium-sized aneurysms of the left anterior descending artery. EN masked the diagnosis of KD, and the patient developed a coronary artery lesion. KD should be considered in the differential diagnosis of refractory EN in pediatric patients.
我们报告了首例证明川崎病（KD）与结节性红斑（EN）之间存在关联的病例。一名3岁女孩以EN作为KD的初始表现就诊。初诊时，她出现40°C的高热、口咽充血、颈部淋巴结肿大以及红紫色皮肤结节，尤其是下肢部位。她诉说颈部和皮肤病变处剧痛。起初，EN的发生被归因于粪便培养中检测到的 spp感染。然而，患者对 spp敏感的大剂量氨苄西林/舒巴坦无反应。作为不明原因发热筛查进行的超声心动图显示左前降支动脉中型动脉瘤。EN掩盖了KD的诊断，该患者出现了冠状动脉病变。小儿难治性EN的鉴别诊断中应考虑KD。
