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Canadian Journal of Infectious Diseases and Medical Microbiology
Volume 23, Issue 3, Pages 137-139
http://dx.doi.org/10.1155/2012/638357
Case Report

Incomplete Kawasaki Disease Associated with Complicated Streptococcus pyogenes Pneumonia: A Case Report

Timothy Ronan Leahy,1,2 Eyal Cohen,2 and Upton D Allen2

1Children’s University Hospital and Institute of Molecular Medicine, Trinity Centre for Health Sciences, St James’s Hospital, Dublin, Ireland
2Division of Infectious Diseases; Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

Copyright © 2012 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A three-year-old boy presented with community-acquired pneumonia complicated by empyema. Streptococcus pyogenes (group A streptococcus) was identified on culture of the pleural fluid. The patient improved with antibiotic therapy and drainage of the empyema.

During his convalescence, the patient developed persistent fever, lethargy and anorexia. His inflammatory markers were elevated, and repeat cultures were negative. Although the patient had none of the classical mucocutaneous features of Kawasaki disease, an echocardiogram was performed, which revealed coronary artery dilation.

The patient was diagnosed with incomplete Kawasaki disease and treated with intravenous immunoglobulin and high-dose acetylsalicylic acid. The fever subsided within 48 h.

To the authors’ knowledge, the present report is the first report of Kawasaki disease associated with complicated S pyogenes pneumonia. It emphasizes the importance of considering incomplete Kawasaki disease among children with persistent fever, the role of echocardiography in diagnosis, and the potential link between Kawasaki disease and superantigen-producing organisms such as S pyogenes.