Hanqin Ye, Kun Yang, Binjie Luo, Geng Ji, Xiaopeng Zheng
This case illustrates that KD can emerge as a burn wound re-epithelializes, at which point the reappearance of fever is easily misattributed to an intercurrent infection. Across the present case and 13 previously reported, primary-source-verified cases, burn-associated KD occurred in children aged 5 years or younger, usually presented within about 2 weeks of the burn, mostly followed modest burns, and responded promptly to IVIG, with acute coronary artery changes observed in a minority (three of 14) that regressed after treatment. Whether burn injury triggers KD or the two co-occur by chance cannot be determined from a single case; the practical message is that clinicians should re-examine all mucocutaneous surfaces and consider KD in any pediatric burn patient with unexplained persistent fever, so that IVIG is not delayed.
BACKGROUND: Kawasaki disease (KD) is a systemic medium-vessel vasculitis of early childhood that, rarely, has been reported during the course of a pediatric burn. Because persistent fever, rash, and mucocutaneous changes overlap with the systemic inflammatory response to a burn wound, KD can go unrecognized, delaying the administration of intravenous immunoglobulin (IVIG), which reduces the risk of coronary sequelae.
CASE DESCRIPTION: A previously healthy 1-year-old boy sustained a 6% total body surface area deep partial-thickness scald to the left lower limb. The wound healed with conservative dressing care and was almost completely re-epithelialized (>99%) by postburn day 10. On that same day, he developed an abrupt, persistent fever that peaked at 39.5°C-40°C and did not respond to empirical antibiotics. Over the next 48 h, he developed bilateral non-purulent bulbar conjunctival injection, erythematous cracked lips with a strawberry tongue, a polymorphous trunk rash, palmoplantar erythema with hand induration, and non-suppurative cervical lymphadenopathy (largest node 20 × 15 mm). Investigations showed neutrophilic leukocytosis (WBC 16.22 × 10⁹/L), a C-Reactive Protein (CRP) level of 42.65 mg/L, mild hyperbilirubinemia and transaminitis, and elevated levels of IL-6, soluble IL-2 receptor, and TNF-α. The platelet count was 456 × 10⁹/L at admission, 384 × 10⁹/L during the acute phase, and increased to 657 × 10⁹/L during convalescence. Infectious and rheumatological differentials were excluded. The patient met all six principal criteria of the JCS/JSCS 2020 guideline, leading to a diagnosis of complete KD. He received IVIG (2 g/kg) and oral aspirin (30 mg/kg/day, tapered after defervescence). Fever resolved within 24 h, followed by periungual desquamation. Transthoracic echocardiography showed a patent foramen ovale without coronary artery abnormalities, and repeat imaging at approximately 1 week and 1 month after onset confirmed normal coronary arteries with no evidence of aneurysms.
CONCLUSION: This case illustrates that KD can emerge as a burn wound re-epithelializes, at which point the reappearance of fever is easily misattributed to an intercurrent infection. Across the present case and 13 previously reported, primary-source-verified cases, burn-associated KD occurred in children aged 5 years or younger, usually presented within about 2 weeks of the burn, mostly followed modest burns, and responded promptly to IVIG, with acute coronary artery changes observed in a minority (three of 14) that regressed after treatment. Whether burn injury triggers KD or the two co-occur by chance cannot be determined from a single case; the practical message is that clinicians should re-examine all mucocutaneous surfaces and consider KD in any pediatric burn patient with unexplained persistent fever, so that IVIG is not delayed.