A Febrile Skin Rash May Hide Another

Manel Hsairi,Fatma Hammemi,Amal Eleuch,Makram Koubaa,Abdelmajid Mahfoudh,Faiza Safi,Lamia Gargouri

doi:10.21601/ejbms/10815

Abstract

Background: Measles mimics Kawasaki disease (KD) as there are many common features. It may be challenging to distinguish KD from measles. However, these two diseases may be associated. Here, we report a case of KD trigged by measles. Case presentation: A 4-year-old girl was hospitalized for a 7-day-history of persistent fever and cough. She had a skin rash, conjunctivitis, cheilitis and cervical lymphadenopathy. Echocardiography showed suggestive signs of KD. The patient was treated with intravenous immunoglobulin relayed by aspirin. Measles serology revealed positive IgM and IgG antibodies. Conclusion: We reported a febrile skin rash which hided another.

Highlights

Kawasaki disease (KD), known as the mucocutaneous lymph node syndrome, is an acute febrile systemic vasculitis that commonly affects infants and young children, mostly below 5 years of age [1]
We presented a case of KD, most likely trigged by measles virus
This suggests that KD could be trigged by an acute viral infection, measles virus in our case, which was responsible for the abnormal immune response

Summary

INTRODUCTION

Kawasaki disease (KD), known as the mucocutaneous lymph node syndrome, is an acute febrile systemic vasculitis that commonly affects infants and young children, mostly below 5 years of age [1]. It may be very challenging to distinguish KD from other febrile infectious diseases including measles, which shares many features with KD, such as fever, skin rash, nonexudative conjunctivitis, generalised lymphadenopathy and malaise [3]. Physical examination on admission revealed a body temperature of 40°C and a generalized maculopapular rash which started 2 days ago. She had conjunctivitis, cheilitis and cervical lymphadenopathy. Her heart rate was 90 beats per minute and the auscultation of the heart revealed no significant abnormality. The patient was discharged from the hospital and continued a low-dose of aspirin at 3 mg/kg/day Her laboratory investigations, 15 days apart, showed an erythrocyte sedimentation rate at 18 mm/h and a normal C-reactive protein (8 mg/L). The same dose of aspirin will be continued until the echocardiography control, 6 months later

Findings

DISCUSSION

CONCLUSION