International Journal of Clinical Pediatrics, ISSN 1927-1255 print, 1927-1263 online, Open Access
Article copyright, the authors; Journal compilation copyright, Int J Clin Pediatr and Elmer Press Inc
Journal website http://www.theijcp.org

Case Report

Volume 8, Number 1, August 2019, pages 12-18

Recurrent Peeling of Skin Following Post-Streptococcal Atypical Kawasaki Disease: A Case Report and Literature Review

Figures

Figure 1.
Figure 1. (a) Chest X-ray (CXR) showing right-sided pleural effusion. (b) Repeated CXR after 48 h showing improvement, chest drain and central line in situ.
Figure 2.
Figure 2. Peeling of the skin during the initial presentation (6 months before).
Figure 3.
Figure 3. Recurrent peeling of the skin and nail damage 6 months later.

Tables

Table 1. Blood Results While Admitted (Arrows Indicate Repeated Results Days Apart)
 
C-reactive protein (mg/dL)348 → 228 → 156 → 75 → 14.5
ESR (mm/h)67 → > 150 → 140 → 48
White blood cell count (× 103/µL)8.1 → 41 → 27.8 → 12 → 11
Complement C3 (g/L)0.45 → 1.67
Complement C4 (g/L)0.05 → 0.22
ALT (IU/L)27 → 67 → 28
AST (IU/L)48 → 38 → 43
Platelets (× 103/µL)99 → 1,001 → 832 → 664
ASO titre (IU/mL)< 50 → 1,825 → 830
Hemoglobin (g/dL)13.4 → 9.1 → 5.7 → 8.2
D-dimer (µg/mL FEU)13.7 → 12.5
Fibrinogen (mg/dL)638 → 497 → 415
Anti-DNase B (U/mL)1,310 → 1,280 → 886

 

Table 2. Blood Results 2 Weeks After Discharge (Arrows Indicate Repeated Results 6 Months Later)
 
C-reactive protein (mg/dL)2.2 → 1.8
ESR (mm/h)48 → 7
White blood cell count (× 103/µL)10.7 → 7.1
ALT (IU/L)28 → 8
AST (IU/L)43 → 24
Platelets (× 103/µL)410 → 299
ASO titre (IU/mL)700 → 268
Hemoglobin (g/dL)10.5 → 12
D-dimer (µg/mL FEU)8.5 → 0.57
Fibrinogen (mg/dL)359 → 308
Anti-DNase B (U/mL)886 → 150

 

Table 3. Blood Results During the Recurrent Skin Peeling (6 Months After the Acute Stage)
 
C-reactive protein (mg/dL)14
ESR (mm/h)15
White blood cell count (× 103/µL)15
Complement C3 (g/L)0.45
Complement C4 (g/L)0.05
ALT (IU/L)18
AST (IU/L)23
Platelets (× 103/µL)455
ASO titre (IU/mL)116
Hemoglobin (g/dL)12.6
D-dimer (µg/mL FEU)0.35
Fibrinogen (mg/dL)359
Anti-DNase B (U/mL)153

 

Table 4. IgG Subclasses (Normal Reference Values) (Arrows Show Repeated Levels and the Last Two Were 3 and 6 Months of Follow-Up)
 
Ig G1 (mg/dL)3,276 → 2,466 → 1,900 → 683 (306 - 794)
Ig G2 (mg/dL)1,038 → 529 → 376 → 106 (68 - 327)
Ig G3 (mg/dL)> 213 → > 213 → 212 → 81 (16 - 94)
Ig G4 (mg/dL)34 → 26 → 17 → 3 (2 - 96)