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Introduction Mucocutaneous lymph node syndrome (MCLS), also known as Kawasaki disease, is an acute febrile rash pediatric disease characterized by systemic vasculitis. During the recovery period, the nail can be seen in the transverse groove.

Cause

The cause is not yet clear. The disease is a certain epidemic and landlord, the clinical manifestations of fever, rash, etc., presumably related to infection. It is generally believed to be a variety of pathogens, including Epstein-Barr virus, retrovirus, or Streptococcus, Propionibacterium infection.

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Related inspection

Body temperature measurement M-mode echocardiography (ME) rash

The Japanese MCLS Research Committee (1984) proposed that the diagnostic criteria for this disease should be determined by satisfying at least five of the following six major clinical symptoms:

1 Unexplained fever for 5 days or longer.

2 bilateral conjunctival hyperemia.

3 The oral and pharyngeal mucosa is diffusely congested, the lips are red and chapped, and the tongue is Yangmei.

4 In the early stage of the onset, the hand and foot were swollen and the palmar sputum was red, and the membranous peeling occurred at the toe end during the recovery period.

5 The genital erythema in the trunk, but no blistering and crusting.

Non-suppurative swelling of 6 cervical lymph nodes with a diameter of 1.5 cm or more. However, if two-dimensional echocardiography or coronary angiography is used to detect coronary aneurysms or dilatation, the four main symptoms can be confirmed.

In recent years, reports of incomplete or atypical cases have increased, about 10% to 20%. There are only 2 to 3 main symptoms, but there are typical coronary lesions. It happens mostly in babies. The incidence of coronary aneurysms in typical cases is similar to that in atypical cases. Once suspected of Kawasaki disease, echocardiography should be performed as soon as possible.

Differential diagnosis

It should be differentiated from various rash infectious diseases, viral infections, acute lymphadenitis, rheumatoid diseases and other connective tissue diseases, viral myocarditis, rheumatoid carditis.

The difference between this disease and scarlet fever is:

1 The rash begins on the third day after the onset of the disease.

2 The rash morphology is close to measles and polymorphic erythema.

3 The age of good hair is the period of infants and young children.

4 penicillin has no effect.

The difference between this disease and juvenile rheumatoid disease is:

1 The fever period is shorter and the rash is shorter.

2 hand and foot hard swelling, showing frequent flushing; 3 types of rheumatoid factor negative.

The difference from exudative polymorphic erythema is:

1 eye, lip, no purulent secretion and pseudomembrane formation; 2 rash does not include blisters and scars.

The difference with systemic lupus erythematosus is:

1 rash is not noticeable on the face.

2 The total number of white blood cells and platelets generally increase.

3 anti-nuclear antibody negative.

4 good age is more common in infants and boys.

There are many similarities with the symptoms of infantile nodular multiple arteries, but the incidence of MCLS is more, the course of disease is shorter, and the prognosis is better. The relationship between the two diseases remains to be studied.

The difference with rash virus infection is:

1 lip flushing, chapped, bleeding, showing bayberry tongue;

2 hand and foot hard swelling, often flushing and late appearance of the toe end membranous peeling;

3 eye conjunctival edema or secretions;

4 The total number of white blood cells and the percentage of granulocytes increased, with the left shift of the nucleus;

6 ESR and C-reactive protein were significantly increased.

The difference with acute lymphadenitis is:

1 neck lymphadenopathy and tenderness are mild, local skin and subcutaneous tissue are not red and swollen;

2 no suppurative lesions.

The difference with viral myocarditis is:

1 coronary artery lesions are prominent.

2 characteristic hand and foot changes.

3 high fever continues to retreat.

The difference with rheumatic carditis is:

1 coronary artery lesions are prominent.

2 No meaningful heart murmur.

3 The age of onset is mainly infants and young children.

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