PMC3370327_01
The clinical presentation of a 10-year-old boy before treatment. Bilateral injected tonsils with a yellowish purulent coating (A). Ultrasound images of the bilateral neck masses suggested cervical lymphadenitis (B, C).
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A physical examination revealed inflamed tonsils with a yellowish purulent coating (Figure 1A) and bilateral neck masses of approximately 5x3 cm2. Soft-tissue neck films showed no evidence of retropharyngeal abscess or masses, whereas a neck ultrasound revealed bilateral hypoechoic masses suggestive of cervical lymphadenitis (Figure 1B, C).
Symptoms during treatment. Maculopapular skin rash with pruritus distributed over the buttocks and lower extremities was apparent 7 days after fever onset (A, B). Strawberry tongue and non-purulent acute conjunctivitis were apparent 8 days after fever onset (C, D). Periungual desquamation of the fingers was apparent 14 days after fever onset (E, F).
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Three days after admission, the patient developed a rough-textured and sandpaper-like erythematous maculopapular skin rash with pruritus on the lower body (Figure 2A, B). Four days after admission, the patient developed strawberry tongue and bilateral conjunctivitis (Figure 2C, D). Fourteen days after the onset of fever, the patient presented to our outpatient department with sheet-like desquamation of the hands, feet, and perianal region (Figure 2E and F).
Echocardiography 20 days after fever onset. A bilateral coronary artery dilatation with a right coronary artery aneurysm is shown: (A) left main coronary artery, 5.2, mm and left anterior descending artery, 5.5 mm; (B) left circumflex artery, 4.4 mm; (C) right coronary artery, 6.5 mm.
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On the same day, echocardiography revealed bilateral coronary artery dilatation with a right coronary artery aneurysm (Figure 3).