All issues > Volume 16(7); 1973

Case Report

J Korean Pediatr Soc. 1973;16(7):565-571. Published online July 31, 1973.

Muco-Cutaneous Lymphnode Syndrome(Five Cases Report)

Chung Sook Park¹, Choon Ji Suh¹, Sung Hoon Cho¹, Du Bong Lee¹

¹Department of Pediatrics, Catholic Medical College Seoul, Korea

Abstract

So-called Muco-Cutaneous Lymphnode Syndrome (MCLS) was reported first in 1967 by Tomisaku Kawasaki Department of Pediatrics, Japanese .Red Cross Central Hospital, Tokyo, Japan and then over 1,857 cases of this syndrome has been reported in Japan recently until 1971. This syndrome was characterized by the continued high fever durated over 10 days. The swelling of cervical lymphnodes simulating Mumps, generalized exanthema or erythemaon hand plam and feet sole which, followed by membranous desquamation and increased vasculascularization of Sclerae. During past year Authors experienced some cases which were most like to this syndrome. Now we attempted to present brieflyfive cases in this paper. Four o£ five cases were Korean and one was Japanese infant who stayed with his parents in this country. Case 1. 2 years old, Korean male admitted with an episode of high fever durated 7 days, erythema and edematous swelling of hand palms and feet soles and Knee-joints on June 13, 1972. On physical examination, hyperremic sclerae, fissured and erosive lips with dry tongue were formed with erythema on hand and feet. On 15th day of illness, the membranous desquamations of fingers and toes which showed the erythematous-swelling at the onset of illness was began. Case 2. 4years old, Korean male admitted with high fever graded 38. 9°C from 7 days ago. On. physical examination, he showed the erosion and bloody crust of lips, hypertrophy of tongue papillae like a straw-berry, hyperemic sclerae and swelling of hands and feet on June 19, 1972. On 2nd day of illness, the swelling of both cervical lymphnodes were appeared, and this was just like the swelling in Mumps. Fever was controlled 4th days of hospitalization and the typical desquamation of fingers and toes appeared on 16th day of illness. Case 3. 9 months old, Korean infant was hospitalized on Aug 11 1972 with the complaints of high fever persisted for 3 days, vomiting and irritability. On physical examination, he was moderately dehydrated, his lips and oral mucous membrane ware reddend and hyperemic. Also both cervical lymphnodes were swallen in size of thumb. Fever was continued until 10th day of illness, and morbiliform rashs and the swelling of fingers and toes appeared at abdomen on the 2nd day of hospitalization after then this exanthem spread to whole body 2 days later. After 10th days of illness, the membranous desquamation was seen in both fingers and toes. Case 4. 2 years old, Korean male admitted with high fever durated 3 days, diarrhea, eryyhematous rashes on palm, sole and anterior trunk on April 23, 1972. On physical examination, he was dehydrated moderately and pale, his lips and oral mucous membrane were dry and hyperemic with erosion like an angle stomatitis, conjuntiva was noted on 6th day of illness, hyperemia of sclerae and there was no erythematous swelling of palms and soles and also no cervical lymphnode was swallen. Fever was controlled after 7th day of illness, the rashs on palms on palms and soles were almost disappeared, on the day before fever was return to normal On 14th day of illness, he had the typical membranous desquamation of fingers, toes and palms. Case 5. 13 months old, Japanese infant admitted on Aug. 17, 1972 under the suspicion of MCLS with uncontrolled high fever which persisted 5 days, irritability, congested eye-ball, morbiliformrashs on face and the swelling of both cervical lymphnodes. After 10 days of acute febrile episode, he discharged from hospital. Six days later he visited at outpatiened clinics with good health, but he presented the membranous desquamation of fingers and toes. Four of them was under two years of age and all were males. In these manifestation, indurative edema and erythema of palms and soles, membranous desquamation and ocular congestion were seen, in all of fivecases, three of them showed the swelling of cervical lymphnodes. On the other hand, irritability with dehydration, reddened lips and congested eye-ball was not worhy as one of the most impressive symptome in this disease when seen the patient first time. Also diarrhea and vomiting were noted in three of them through the course of this illness. In. laboratory findings, leukocytosis was noted in four of them 15, 000,25, 000/mm3, ESR was mode rately elevated in 24^30 mm/hr. ASTO tite was below 1 : 125 except case 2, CRP showed strong positive(l) in all of them. And two of them presented elevated a2-globulin fraction. On chest X-ray, case 5 showed the peribronchial infiltration on both lungs, two of these sick children showed the elevation ofST segment in these electrocardiograms.

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