Lim Kimberley Ying Ying, Chua Mei Chien, Tan Natalie Woon Hui, Chandran Suresh
Paediatrics, National University Singapore Yong Loo Lin School of Medicine, Singapore.
Department of Neonatology, KK Women's and Children's Hospital, Singapore.
BMJ Case Rep. 2020 Dec 17;13(12):e239648. doi: 10.1136/bcr-2020-239648.
The aetiology of febrile exanthems in children is often difficult to distinguish clinically. A diagnosis of Kawasaki disease (KD) should be considered in infants with exanthematous fever. More perplexing is the increasing incidence of an atypical form of KD. Pathogenesis of KD remains unclear even though an aberrant response of the immune system to an unidentified pathogen is often hypothesised. A 30-fold increase in the incidence of KD in Italy during the SARS-CoV-2 pandemic suggests an immune response to a viral trigger. We report an infant clinically diagnosed with high probability as incomplete KD, who presented with reactivation of the BCG injection site even though fever with rash was only less than 3 days duration. Echocardiography confirmed coronary artery abnormalities and prompt treatment with intravenous immunoglobulin facilitated rapid recovery. Physicians should consider a diagnosis of KD if BCG site reactivation is noted in children presenting with febrile exanthema.
儿童发热性皮疹的病因在临床上往往难以区分。对于患有皮疹性发热的婴儿，应考虑诊断为川崎病（KD）。更令人困惑的是，非典型KD的发病率在不断上升。尽管常推测免疫系统对未知病原体的异常反应是KD的发病机制，但KD的发病机制仍不清楚。在新冠病毒大流行期间，意大利KD的发病率增加了30倍，这表明对病毒触发因素有免疫反应。我们报告了一名临床高度疑似不完全KD的婴儿，尽管发热伴皮疹仅持续不到3天，但卡介苗注射部位出现了再激活。超声心动图证实有冠状动脉异常，静脉注射免疫球蛋白的及时治疗促进了快速康复。如果在出现发热性皮疹的儿童中发现卡介苗接种部位再激活，医生应考虑诊断为KD。
