P396 Kawasaki disease and group a streptococcal infection: a case report

Backgroud Kawasaki disease (KD) is an acute multi- system vasculitis which primarily affects children. Although the etiology remains unknown, it seems that KD is a response to superantigens in genetically susceptible individuals. It was reported that treatment with intravenous immunoglobulin (IVIG) is empirically effective because it inhibits bacterial superantigen induced production of proinflammatory cytocines. Case presentation summary A six-year-old boy presented with a history of fever for 5 days. Based on a positive strep test and typical red rash he was diagnosed with scarlet fever and was under treatment with amoxicillin. His clinical examination revealed bilateral conjunctival infection without exudate, cracked lips, strawberry tongue, injection of pharyngeal mucosa, maculopapular rash and unilateral cervical lymphadenopathy. Investigations showed increased WBC count, ESR=52 mm/hr, CRP=143 mg/lt and elevated liver enzymes. The film array test for upper respiratory tract infection was negative. He fulfilled the criteria of KD, so he was started on IVIG and acetylsalicylic acid. He required more than one dose of IVIG in order to demonstrate an effect. On the 13th day periungual peeling of fingers and elevated PLTs appeared. After the therapy administration, eosinophilia was observed . The periodic cardiological evaluation was negative. Learning points/Discussion Features of KD are similar to those found in certain illnesses which are caused by toxin-producing bacteria such as scarlet fever. Certain patients require more than one dose of IVIG before demonstrating an effect because there is a threshold level of IgG which is necessary to reduce the clinical signs of inflammation. The identification of causative agents will result in the development of less expensive and more specific therapies.