Kawasaki disease presenting as BCG scar reactivation in a five weeks old baby

Kawasaki disease (KD) is an acute febrile illness of childhood of unknown origin. KD often affects children younger than five years [1]. However the incidence of KD in infants less than three months is very low [2].The diagnosis is made according to clinical criteria. Classic KD is diagnosed based on the presence of fever lasting for five or more days, accompanied by four out of five criteria. These criteria are: bilateral bulbar conjunctival injection (without exudate), polymorphous rash, changes in oral cavity and lips, cervical lymphadenopathy and characteristic changes in extremities. Presence of two or three of above criteria associated with fever lasting five or more days constitutes incomplete KD [1]. Although BCG scar reactivation is not included as diagnostic criteria, it is a useful clinical finding which aids in the diagnosis of KD in infants [3]. Cytokines like interleukin-1β and tumor necrosis factor-α has been detected in elevated levels at the BCG inoculation site [4].