Abstract 49: Kawasaki Disease With Tsutsugamushi Disease: A Case Report

Background : Clinical and epidemiologic features suggest infectious agents as a possible cause of Kawasaki disease; however, the etiology of Kawasaki disease still remains unknown. A number of microorganisms were hypothesized as an etiology of the illness. This is the first reported case of Kawasaki disease with tsutsugamushi disease. Case presentation: We report the case of a 4-year-old boy who presented with fever of 7 days duration and skin rash and bilateral conjunctival injection. He had a history of visiting a rural area with his grandmother. On admission, he had fever of 39.4 °C. His heart rate was 90/minute and his blood pressure was 90/60 mmHg. His pharynx was slightly injected and there was red lip. His neck was swollen with cervical lymphadenitis. He had erythematous macular rash on her trunk. Examination of his skin revealed an eschar on penile base of right scrotum. His laboratory results showed WBC 4,720/mm 3 , 42% polymorphonuclear leucocytes, 39% lymphocytes, hemoglobin 10.3 gm/dL, platelet count 148,000/mm 3 , CRP 3.23mg/dl, pro-BNP 316.5 pg/ml. The respiratory viruses using a multiplex real-time-PCR kit (Adenovirus, Influenza A, Influenza B, Metapneumovirus, Rhino A virus, Respiratory syncytiai virus, Parainfluenza ) were all negative. Mycoplasma pneumonia IgM was negative. R.tsutsugamushi Ab was positive. Echocardiographic findings 1 day after admission was mild dilatation of LCA (RCA=1.8mm, LCA=3mm). He was treated on oral roxithromycin for presumptive diagnosis of tsutsugamushi disease along with clinical features of Kawasaki disease which resolved after therapy with intravenous immune globulin and aspirin. Over the next 48 hours, he became afebrile and his rash improved. He was placed on low-dose aspirin for 8 weeks. His echocardiogram were within normal limit (RCA= 1.9mm, LCA= 2.7mm) at 2 months after the onset of his illness. Conclusion: This case report suggests that Kawasaki disease can rarely occur concurrently or immediately after a rickettsial illness such as tsutsugamushi disease.