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A previously healthy 8-month-old girl presented with fever, conjunctival congestion, reddening of the lips, and erythema at the site of bacillus Calmette–Guérin inoculation. She was diagnosed with Kawasaki disease (KD) and treated with intravenous immunoglobulin, prednisolone (PSL), and aspirin. Impetigo-like psoriasiform eruption developed in acute phase of KD after these treatments, although her fever and general condition improved. Furthermore, following tapering and discontinuation of PSL, the eruption spread throughout the body (Fig. 1). Skin biopsy revealed hyperkeratosis and parakeratosis, spongiotic changes in the epidermis, neutrophil infiltration into the stratum corneum, and mild perivascular lymphocytic infiltration in the upper dermis. The patient was subsequently diagnosed with psoriasiform eruption complicated by impetigo. The eruption was refractory to oral antibiotics and topical steroids, necessitating resumption of oral PSL. The eruption gradually improved over 90 days. Psoriasis-like eruption occurs in approximately 1.9% of cases of KD and are frequently accompanied by crusting lesions representing multiple forms of psoriasis, including plaque, guttate, and pustular psoriasis [1, 2]. Inflammatory cytokines, including interleukin (IL)−17 and IL-22, produced during the acute phase of KD significantly contribute to the pathogenesis of psoriasis-like eruption [3]. Although the rash may resolve without treatment, it is typically managed with topical steroids; in refractory cases, systemic corticosteroids and/or cyclosporine may be administered.
Fig. 1
Psoriasiform eruption. Psoriasiform eruptions were observed on bilateral cheeks (A), extremities (B) including the BCG vaccination site (C)
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