Nonresolving pneumonia and rash in an adult: pulmonary involvements in Kawasaki's disease

Abstract

To the Editors : Slowly resolving or nonresolving pneumonia is a challenge for physicians. The most common clinical error when approaching these patients is to subsequently treat the patient with different antibiotics over an extended period of time, without questioning the cause of treatment failure. Mostly, slowly resolving pneumonias are due to host defence or infectious causes. Nonresolving pneumonias are usually of noninfectious origin and, in the majority of cases, require invasive diagnostic techniques to be confirmed. Nonresolving or slowly resolving pneumonia should direct the clinician to a critical re-evaluation of the possible causes of the disease. A 19-yr-old male without known comorbidity reported to a general practitioner with fever, headache, sore throat and diarrhoea. A few days later, after being treated with amoxicillin/clavulanate, he developed a generalised erythema and rash, starting on the abdomen. Already severely impaired, he later went to a primary care centre. Based on his dermatological alterations, staphylococcal toxic shock syndrome was suspected and antibiotics where changed to penicillin and clindamycin. However, the condition worsened; the patient developed dyspnoea, dry cough and bilateral reticulo-nodular infiltrates on chest radiograph. He was transferred to our university hospital because of imminent respiratory failure. On admission he was still febrile (38.5°C), had generalised oedema and required 6 L·min−1 oxygen to achieve a saturation of 96% (arterial blood …