A girl with acute generalized exanthematous pustulosis who presented similar symptoms of Kawasaki disease

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  • 川崎病との鑑別を要した急性汎発性発疹性膿疱症の1女児例

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We experienced a 8 year-old girl with acute generalized exanthematous pustulosis (AGEP) who fulfilled with the diagnostic criteria of Kawasaki disease (KD). On admission, she had fever, generalized erythema, injected eyes, flushed lip, swelling of extremities. We found elevated white blood cell count, C-reactive protein and reduced concentration of serum albumin, and sodium. We suspected KD, but administered antimicrobials intravenously because of day 2 of fever and no abnormality finding of echocardiographic examination. The following day, we reached a diagnosis of AGEP for many small pustules on generalized erythema. She brought down fever on the 3th day after admission. We discontinued antimicrobials on the 4th day. Erythema and pustules gradually disappeared. Desquamation appeared on the 5th day. She discharged hospital on the 6th day. We considered acetaminophen as a causative drug from the positive results of drug lymphocyte stimulation test in 4th day and 2 months after onset. It might happen that AGEP would be worsening from misdiagnosis and administer of offending drug because of clinical resemblance to KD and sepsis. We need to recognize it a type of severe eruption while rare with child.

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