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Letter
Multifocal lymphadenopathy associated with severe Kawasaki disease: a difficult diagnosis
  1. F Falcini1,
  2. G Simonini1,
  3. G Battista Calabri2,
  4. R Cimaz3
  1. 1Rheumatology Unit, Department of Paediatrics, University of Florence, Italy
  2. 2Paediatric Cardiology Unit, A Meyer Children Hospital, Florence, Italy
  3. 3Istituti Clinici di Perfezionamento, Milan, Italy
  1. Correspondence to:
    Dr F Falcini, Department of Paediatrics, Rheumatology Unit, Via Pico della Mirandola 24, 50132 Florence, Italy;
    falcini{at}unifi.it

https://doi.org/10.1136/ard.62.7.688

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    CASE REPORT

    A previously healthy 3½12 month old infant was admitted to the hospital with dyspnoea, malaise, and irritability in August 2001. One week before he had had an upper respiratory infection treated with amoxycillin and inhaled steroids; the day before admission he presented high grade (up to 40°C) temperature.

    On admission he was febrile (39°C), pale, restless; his respiratory rate was 50/min and pulse 120 beats/min. Clinical evaluation showed oral cyanosis, redness of the pharynx, and bilateral suppurative conjunctivitis. A chest radiograph showed pulmonary infiltrates in the right lung.

    Electrocardiography (ECG) and echo colour Doppler excluded cardiac abnormalities. An electroencephalogram showed diffuse slow waves. A lumbar puncture was performed to exclude a meningeal infection; the cerebrospinal fluid was clear with normal glucose and protein levels and a mild increase in mononuclear cells.

    Blood tests showed: erythrocyte sedimentation rate (ESR) (Westergren) 120 mm/1st h, C reactive protein (CRP) 221 mg/l, white blood cells 16.8×109/l (neutrophils 75.2%), haemoglobin 94 g/l, and platelet count 504×10 …

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