Tanaka Tsukasa, Shimizu Masaki, Tokuda Oshi, Yamamoto Hiroko, Matsunoshita Natsuki, Takenaka Kanae, Kawasaki Keiichiro
Department of Pediatrics, Kita-Harima Medical Center, Ono, Hyogo, Japan.
Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical, Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan.
Case Rep Pediatr. 2020 Oct 28;2020:8889827. doi: 10.1155/2020/8889827. eCollection 2020.
Kawasaki disease (KD) is typically characterized by fever, oral cavity erythematous changes, bilateral bulbar conjunctival injection, skin rash, erythema and edema of the hands and feet, and cervical lymphadenopathy. Some atypical patients with KD initially develop cervical and pharyngeal cellulitis; however, an initial presentation with inguinal cellulitis is extremely rare. In addition, to our knowledge, no report has documented the cytokine profile in a KD patient with cellulitis. . A previously healthy 8-year-old Japanese girl was hospitalized following a 2-day history of fever and a 5-day history of pain and erythema in the left inguinal region. She was diagnosed with bacterial inguinal cellulitis and was administered antibiotics. The next day, a polymorphous rash emerged on her trunk. After 3 days of antibiotics, however, her fever continued and the cellulitis had spread over the entire lower abdomen. Simultaneously, the bilateral bulbar conjunctival injection without exudate became more prominent and her lips became erythematous. In addition, erythematous changes on her palms appeared a few hours later, which led to the diagnosis of KD. Since she had a high risk score that predicted no response to initial intravenous immunoglobulin (IVIG) at the initiation of treatment, she was treated with IVIG, intravenous prednisolone (PSL), and oral aspirin. The KD symptoms improved the next day, but the cellulitis did not completely resolve until 2 months after discharge. The patient's serum cytokine profile at admission had an IL-6 dominant pattern which was consistent with that of patients with KD despite her initial lack of KD symptoms, and the pattern observed at admission was sustained until IVIG and PSL administration.
KD should be included in the differential diagnosis for patients presenting with inguinal cellulitis who are unresponsive to initial empiric antibiotics.
川崎病（KD）的典型特征为发热、口腔黏膜红斑改变、双侧球结膜充血、皮疹、手足红斑及水肿，以及颈部淋巴结肿大。一些非典型KD患者最初表现为颈部和咽部蜂窝织炎；然而，以腹股沟蜂窝织炎为首发表现极为罕见。此外，据我们所知，尚无报告记录过患有蜂窝织炎的KD患者的细胞因子谱。一名此前健康的8岁日本女孩因发热2天及左侧腹股沟区疼痛和红斑5天入院。她被诊断为细菌性腹股沟蜂窝织炎并接受了抗生素治疗。次日，她的躯干出现多形性皮疹。然而，使用抗生素3天后，她仍持续发热，蜂窝织炎已蔓延至整个下腹部。同时，双侧无渗出物的球结膜充血变得更加明显，且她的嘴唇出现红斑。此外，数小时后她的手掌出现红斑改变，这导致了KD的诊断。由于她在治疗开始时的风险评分提示对初始静脉注射免疫球蛋白（IVIG）无反应，她接受了IVIG、静脉注射泼尼松龙（PSL）和口服阿司匹林治疗。KD症状次日有所改善，但蜂窝织炎直到出院后2个月才完全消退。尽管该患者最初缺乏KD症状，但其入院时的血清细胞因子谱呈现以白细胞介素-6为主的模式，这与KD患者一致，且入院时观察到的模式在给予IVIG和PSL之前一直持续。
对于初始经验性抗生素治疗无效的腹股沟蜂窝织炎患者，鉴别诊断时应考虑川崎病。
