https://orcid.org/0000-0001-5486-4267
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Aaqib Zaffar Banday, Harsha Neelam, Mini P Singh, Murugan Sudhakar, Ankur Kumar Jindal, Severe lip excoriation in Kawasaki disease: beware of herpes simplex virus, Rheumatology, Volume 59, Issue 10, October 2020, Pages 3115–3116, https://doi.org/10.1093/rheumatology/keaa081
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A 7-year-old boy presented with history of fever, throat pain, maculopapular rash, oral ulcers, swelling and cracking of lips and difficulty feeding. He was diagnosed to have Kawasaki disease (KD) at a nearby healthcare facility and was treated with 2 g/kg of intravenous immunoglobulin (IVIg). His fever improved within 36 h of completion of IVIg infusion. He was referred to us in view of persistent orolabial involvement. On examination, he had excoriation and erythema of lips, ulcers over lips and buccal mucosa, periungual and perineal peeling of skin. He also had elevated inflammatory parameters [C-reactive protein: 22.47 mg/l (normal <6.0) and procalcitonin: 1.16 ng/ml (normal <0.5)]. Coronary artery ‘Z’ scores were normal on 2 D echocardiography. IgM anti-herpes simplex virus (HSV)-1 serology was found to be reactive. He was initiated on oral acyclovir (10 mg/kg/dose, three times a day) and the mucosal lesions subsided. Erythema and cracking of lips is a useful clinical sign for diagnosis of KD. However, ulcerations and extensive lip involvement has rarely been reported [1]. Viral triggers have been commonly reported in KD. However, HSV as a trigger for KD has not been reported. It is prudent to screen for viruses, especially HSV, in children with KD and severe mucocutaneous involvement [2].
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