Erythema multiforme as first sign of incomplete Kawasaki dis
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Kawasaki disease is an acute, self-limited vasculitis of unknown etiology with a predilection for the involvement of coronary arteries, that affects predominantly infants and young children. The diagnosis is based on the presence of fever associated with other transient typical signs, that rarely are simultaneously present at the time of first observation, but can appear subsequently. Indeed, there is no single pathognomonic clinical or laboratoristic finding for certain diagnosis. However, early recognition of Kawasaki disease is important to promptly start adequate therapy with intravenous immunoglobulins to prevent the development of coronary aneurysms. Diagnosis of incomplete Kawasaki disease is even more difficult for pediatricians, because in the absence of classical presentation, vasculitis could be misdiagnosed and recognized late; moreover, the incomplete form is at risk of heart complications, too. Cutaneous manifestations are one of the diagnostic criteria in Kawasaki disease, but they are variable and non specific. Even if the typical findings of cutaneous changes are multiple symmetrical erythematous eruptions on the extensor surfaces of the extremities developing after 3–5 days of fever, Kawasaki disease may rarely present as erythema multiforme. We report here on a case of a 4 years old boy with erythema multiforme as presenting sign of incomplete Kawasaki disease.

Case presentation
A 4 years old boy was admitted to our Hospital for a one day history of remittent fever (up to 40.0°C), accompanied by irritability and annular, slightly itchy rash, started on his hands and feet and progressively extended to the flexor and extensor surfaces of the extremities, with relative sparing of the trunk. The child appeared extremely suffering. Physical examination showed bilateral lymphadenopathy (< 1.5 cm diameter) and hyperemic pharynx without exudate. The child did not report abdominal pain or arthralgia. Initial laboratoristic evaluation showed marked lymphocitosys with neutrophylia, hyponatremia and evidence of systemic inflammation....