Emergency: requires immediate attention
Kawasaki disease - Anogenital in
See also in: Overview,External and Internal Eye,Oral Mucosal LesionAlerts and Notices
Synopsis
- Conjunctival injection without exudate
- Red lesions of the mouth or pharynx
- Acute hand and foot edema followed by peeling
- Polymorphous cutaneous eruption
- Lymphadenopathy (usually cervical)
The most significant and potentially life-threatening complications are cardiovascular. Pericarditis, myocarditis, coronary arteritis, and endocarditis leading to arrhythmias can occur as early as 7 days from the onset of fever.
A multisystem inflammatory syndrome potentially linked to COVID-19 has been reported in children and young adults; clinical features include Kawasaki-like and toxic shock syndrome-like presentations.
Childhood sexual abuse is a problem of epidemic proportions affecting children of all ages and economic and cultural backgrounds. A variety of dermatologic conditions causing erythema of the perineum, including KD, should be considered when sexual abuse is suspected. Although awareness is increasing, it is often challenging to differentiate findings attributable to child abuse from those of other benign anogenital skin conditions.
Codes
ICD10CM:M30.3 – Mucocutaneous lymph node syndrome [Kawasaki]
SNOMEDCT:
75053002 – Kawasaki disease
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Multisystem inflammatory syndrome in children (MIS-C) – In contrast to classic KD, desquamation in the groin is uncommon or absent.
- Patients with toxic shock syndrome most often have focal cutaneous skin infections, abscesses, infections associated with nasal packing, or a history of recent surgical procedures.
- COVID-19
- Erythema multiforme presents with symmetrically distributed target lesions. Patients frequently have coexisting herpes orolabialis.
- Viral exanthems like measles may be difficult to distinguish from KD. However, patients with measles often display an exudative conjunctivitis and Koplik spots within the oral mucosa.
- The cutaneous and mucosal findings in scarlet fever may also easily be confused with KD. However, these patients respond to anti-streptococcal antibiotic therapy.
- Staphylococcal scalded skin syndrome presents with erythema and desquamation accentuated within skin folds.
- Distinguishing drug reactions (eg, Stevens-Johnson syndrome) from KD can be difficult. A careful drug history is critical.
- KD can present with red cheeks, as does fifth disease (erythema infectiosum). Premature closure on fifth disease leading to missing KD is a diagnostic pitfall.
- Behçet disease
- Contact dermatitis (allergic and irritant)
- Seborrheic dermatitis
- Candidiasis
- Psoriasis
- Sexual abuse
Best Tests
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Therapy
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References
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Last Reviewed:08/08/2018
Last Updated:12/11/2022
Last Updated:12/11/2022
Emergency: requires immediate attention
Kawasaki disease - Anogenital in
See also in: Overview,External and Internal Eye,Oral Mucosal Lesion