Adult-onset Kawasaki disease (mucocutaneous lymph node syndrome) and concurrent Coxsackievirus A4 infection: a case report

Ueda, Yuki; Kenzaka, Tsuneaki; Noda, Ayako; Yamamoto, Yu; Matsumura, Masami

At the time of admission to our hospital, the patient was clearly conscious. His temperature was 37.7°C, blood pressure was 136/84 mmHg, pulse rate was regular at 88 beats per minute, and respiratory rate was 28 breaths per minute. Physical examination showed desquamation around the lips ( Figure 1A ), fingers ( Figure 1B) , and feet ( Figure 1C ). Edematous erythema was noted on his trunk, extremities, axillae, flank, and hip. There was also brawny edema of the hands and feet and marked congestion of the conjunctivae ( Figure 1D ). His lips were reddish, dry, and swollen. His palatine tonsils were also slightly red. The cervical lymph nodes were not enlarged. The chest was clear to auscultation. The abdomen was soft and non-tender. No arthritis was noted, and neurological examination also yielded normal results. Laboratory data on admission revealed leukocytosis, neutrophilia, and thrombocytosis, and serum aspartate aminotransferase, alanine aminotransferase, creatinine, and C-reactive protein levels were elevated (Table 1) . Repeat blood culture was sterile. Rapid test for Streptococcus pyogenes antigen was negative. The presence of antibodies to Epstein-Barr virus and cytomegalovirus indicated past infections (Table 2) . Chest radiography showed no abnormalities.