A 3-yo boy presented with 5 days of fever, lip ulcerations, diffuse blanching maculopapular rash, and bilateral nonpurulent conjunctivitis. This lesion was noted in the area of his BCG scar. What is the diagnosis?
Rubeola
Disseminated TB
Rocky Mountain spotted fever
Toxic epidermal necrolysis
Kawasaki disease
You are correct. Localized erythema over a BCG scar is a recognized feature of Kawasaki disease. It is thought to be due to cross reactivity of heat shock proteins in the scar and T cells. Strawberry tongue is another notable feature. Treatment is with aspirin and IVIG. If untreated, some patients will develop coronary aneurysms.