Abstract
The cutaneous features of 10 children fulfilling all 6 criteria of Kawasaki Disease (KD) (J Inf Dis 137:91, 1978) were studied prospectively during a 1979-1980 epidemic in Massachusetts. Discrete and confluent pink papules, plaques, and erythema that changed in pattern from hour to hour, interspersed by areas of uninvolved skin and distributed over the head, torso and extremities, began 1-5 days (d) after the first sign or symptom of illness, median (m)=1.5d, and persisted 7-16d (m=10d). Annular plaques, scarlatiniform truncal and genital erythema, and patchy fine scaling were frequent. Iris lesions were not observed. The exanthem antedated palm/sole inflammation by 0-6d, m=2d. Multiple minute pustules mainly on the proximal extremities within red areas were noted in 8 cases 2-8d (m=6.5d) after the onset of the rash, lasting 2-4d, m=2d. Smears of the pustules showed sterile collections of neutrophils. Paraffin (7) and epon-embedded (3) sections manifested variable epidermal alterations and marked perivascular inflammation of the superficial venular plexus, but frank necrotizing venulitis was not observed. Direct immunofluorescence studies were non-revealing. The exanthem of KD, occasionally mistaken for other diseases in the early phase, has some unique features, but “time” is often required for their evolution and recognition. Evanescent tiny pustules, not described previously, appear to occur frequently. Histologic changes, though not specific, may aid diagnosis.
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Rhodes, A., Murphy, G., Bernhard, J. et al. 1059 TRANSIENT PUSTULES AND THE EXANTHEM OF KAWASAKI DISEASE. Pediatr Res 15 (Suppl 4), 619 (1981). https://doi.org/10.1203/00006450-198104001-01085
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DOI: https://doi.org/10.1203/00006450-198104001-01085