Asia Pacific Journal of Pediatric and Child Health

Abstract Ref Number = APCP767

Poster Presentation

HAND, FOOT, AND MOUTH DISEASE MIMICKING KAWASAKI DISEASE, A POTENTIAL CAUSE OF MISDIAGNOSIS

Vini Jamarin,Pebriansyah Pebriansyah,Dedi Wilson Bunda Women and Children Hospital Jakarta

Background : Kawasaki disease is an idiopathic acute vasculitis in children under five years, mostly in children 18-24 months, which is characterized by persistent fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, rashes and changes in extremities, and cervical lymphadenopathy. High-grade fever, multiple rashes in extremities and oral cavity which are also found at Hand, Foot, and Mouth Disease (HFMD) could lead to misdiagnosis. Case Presentation Summary : A 2-year-old boy was admitted with chief complaint of persistent fever (day 6). On physical examination, he presented with bilateral conjunctivitis, cracked lips, strawberry tongue, palpable left colli lymph node, edema extremities, and maculopapular multiform lesions on hands and feet. No history of upper respiratory tract infection. At first he was treated as an HFMD with antiviral and symptomatic treatment but did not show any progression. Laboratory investigation showed anemia (Hb 10.1 g/dL), leukocytosis (47600/uL with 88% neutrophil), thrombocytosis (526000/uL), hypoalbuminemia (2.5 g/dl), an extremely elevated C-reactive protein (338.9 mg/L), and a nonreactive ASTO. Kawasaki disease was suspected. ECG showed sinus rhythm, normoaxis, with no sign of ischemia. Echocardiography showed perivascular brightness on cardiac tissues, normal coronary artery with good contractility. Intravenous immunoglobulin (2 g/kg) in 12 hours and high-dosage aspirin (80 mg/kg per day in 4 doses) were administered. His fever disappeared in 24 hours. Edema decreased, conjunctivitis improved, and rashes turned into hyperpigmented lesion in three days. Repeated laboratory test showed decreased WBC count of 28000/uL and CRP of 57.1 mg/L. Patient was discharged after 6 days of hospitalization with aspirin 5 mg/kg/day for 6 weeks Learning Points/Discussion : Potential misdiagnosis of Kawasaki Disease with HFMD could arise from quite similar symptoms and signs. Kawasaki disease should not be overlooked in the differential diagnosis of a patient with persistent high fever and multiple extremities rashes, because a delay could result in coronary artery aneurysms or other cardiac complications.

Keywords: kawasaki disease hand foot and mouth disease rash misdiagnosis