Frontiers in Pediatrics (Oct 2021)

Case Report: Kawasaki Shock Syndrome With Polycyclic Eruption: A Peculiar Brain Imaging

  • Enrico Masiello,
  • Danilo Buonsenso,
  • Ilaria Lazzareschi,
  • Antonio Gatto,
  • Marco Piastra,
  • Antonio Chiaretti,
  • Piero Valentini

Journal volume & issue
Vol. 9


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Kawasaki disease (KD) is a childhood vasculitis of unknown etiology. The present study describes a case of KD shock syndrome that occurred in an infant (age, 16 months) following 7 days of high fever and persistent rash characterized by target-like and purpuric skin lesions. The child developed neurological manifestations such as altered consciousness and irritability. Consequently, brain magnetic resonance imaging (MRI) was performed, revealing an inflammatory involvement of the anterior perforated substance and the hypothalamus. Cerebral involvement on brain MRI is rarely described in KD but when reported is characterized mostly by cerebral vasculitis. We illustrate for the first time in KD an inflammation in the brain not related to vasculitis, reporting peculiar neuroradiological findings. This last aspect has fascinated us in light of recent evidence about the immunological spectrum of Multisystem Inflammatory Syndrome in Children (MIS-C) and Kawasaki-like syndrome in the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) outbreak.