Forum for Nordic Dermato-Venereology Nr1,2019 | Page 27

Case Report Kawasaki Disease: Two Episodes of Recurrent Disease in a Greenlandic Inuit Boy L uit P enninga 1 , A nne K athrine L orentzen 1 and C arsten S auer M ikkelsen 2 Ilulissat Hospital, Ilulissat, Avannaa Region, Ilulissat Hospital, Postbox 514, 3952 Ilulissat, Greenland, and 2 Clinic in Der- matology, Brønderslev, Denmark. E-mail: [email protected] 1 K awasaki disease is a vasculitis of medium-sized arteries presenting with mucocutaneous manifestations and lymphadenopathy (1, 2). Kawasaki’s syndrome typically oc- curs in childhood, and is commonly confused with infectious exanthemas (3). This case report outlines the characteristics of the condition. Patients typically present with fever and erythema of the lips and oral mucosa, rash, and changes in the extremities, includ- ing erythema of the palms and soles, bilateral non-exudative conjunctivitis and cervical lymphadenopathy. These classical features normally develop after a short course of respiratory or gastrointestinal symptoms (1). Normally, Kawasaki disease is self-limiting (3). Often the fever and mucocutaneous manifestations resolve within 10–12 days without treatment (4). The major problem of the disease is the occurrence of cardiovascular complications, which may cause significant morbidity and mortality (5). Patients can develop aneurysms of the coronary arteries, reduced contractility of the myocardium, heart failure, cardiac arrhythmias, and occlusion of peripheral arteries (5). Fig. 1. Erythema of the lips and oral mucosa. Recurrence of Kawasaki disease with new episodes of fever, mucocutaneous manifestations and lymphadenopathy is rare (6, 7). We report here an Inuit boy in Greenland who experienced two episodes of Kawasaki disease. C ase report A 10-month-old Greenlandic Inuit boy was admitted to the local hospital. He had been coughing and spiking fevers for a few days. Due to pulmonary crepitations he was started on oral antibiotics. The fever persisted, and he developed the classical erythema of the lips and oral mucosa (Fig. 1), rash, palm and sole erythema, bilateral non-exudative conjunctivitis (Figs 2 and 3) and cervical lymphadenopathy. He was treated with intravenous (IV) immunoglobulins and recovered. Echocardio­ graphy was performed and slight dilatation of the coronary arteries was seen. He started treatment with acetylsalicylic acid. After 2 months he was re-admitted with fever, general malaise, and had recurrence of all the classic symptoms of Kawasaki disease; erythema of the lips and oral mucosa, rash, changes Forum for Nord Derm Ven 2019, Vol. 24, No. 1 Fig. 2. Non-exudative conjunctivitis. 25