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A Case of Multiple Septic Arthritis by Streptococcus pneumoniae in Kawasaki Disease

Korean Journal of Pediatrics 2004;47(5):579-582.
Published online May 15, 2004.
A Case of Multiple Septic Arthritis by Streptococcus pneumoniae in Kawasaki Disease
Jae-Hoon Choe1, In-Gyu Lee1, Kyung-Bae Park1, Joon-Soo Park1, Young Chang Kim1, Hwa-Yong Song2, Byung-Heum Kim2
1Department of Pediatrics, College of Medicine, Soonchunhyang University, Chonan, Korea
2Department of Orthopedic Surgery, College of Medicine, Soonchunhyang University, Chonan, Korea
가와사키병에서 폐렴구균에 의한 다발성 화농 관절염 1례
최재훈1, 이인규1, 박경배1, 박준수1, 김영창1, 송화용2, 김병흠2
1순천향대학교 의과대학 소아과학교실
2순천향대학교 의과대학 정형외과학교실
Correspondence: 
Joon-Soo Park, Email: pjstable@schch.co.kr
Abstract
In Kawasaki disease, arthritis may occur, generally affecting the hands, knees, ankles, or hips. Operations have not usually been needed. We report a case of Kawasaki Disease with multiple septic arthritis which was caused by S. pneumoniae and which needed athrotomy with drainage for both hips, both knees, and both ankle joints. A two year, ten-month-old girl was admitted to our pediatric department. She had a high fever for four days, erythema of the oral and pharyngeal mucosa with a "strawberry" tongue and dry, cracked lips and scarlatiniform rash around the neck and in the groin area, perianal desquamation and a nonsuppurative left cervical lymphadenopathy. At first, we diagnosed her condition as typical Kawasaki disease, and treated her with intravenous immunoglobulin(IVIG) and aspirin. On the sixth admission day, arthralgia developed in both hip joints. She refused to bear weight on the both lower limbs and resisted all passive motion of the hip. An ultrasonogram of the both hip joints revealed an effusion, and four milliliters of grossly purulent material was aspirated from them. Gram staining of this material showed many leukocytes and Gram-positive diplococci. The finding was consistent with septic arthritis. An open arthrotomy of the hip was done and antibiotics prescribed. On the 7th admission day, the findings of multiple athritis were found including ultrasonogram, in both hips, both knees, both ankles, both shoulders, and both elbow joints as well as both wrist joints. The purulent material culture from the left hip and right knee joints' fluid revealed S. pneumoniae. On the 9th and 11th admission day, arthrostomy was performed on the both hips, both knees, and both ankle joints.
Key Words: Kawasaki disease, Septic arthritis, Streptococcus pneumoniae


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