Kawasaki Disease Presenting as Acute Scrotum

Scientific Letter
  • 106 Downloads
To the Editor: Kawasaki Disease (KD), being a vasculitis of medium-size vessels, can possibly affect any organ. We encountered a five-mo-old child presenting with 7 d of fever and erythema of the scrotal sacs, with pain and desquamation of the overlying scrotal skin. The scrotal sacs were tender on palpation and the temperature of the overlying skin was raised. The scrotal sacs were also enlarged bilaterally. Initially the child had been referred to surgeon with suspicion of testicular torsion and later treated with antibiotics for scrotal abcess. However, the child showed no improvement. When we encountered the case, we observed maculo-papular rash on body, bilateral pedal edema and mucositis of lips and oropharynx. There was desquamation of skin in the perineum and lower part of the trunk. Child was extremely irritable. Mother gave history of bilateral non-purulent conjunctivitis. Transillumination test and Prehn’s sign were negative. Ultrasound Doppler of the testes showed increased vasculature of the testis bilaterally. Echocardiogram revealed dilatation at the origin of left anterior descending artery. A diagnosis of KD was made and intravenous immunoglobulin was given along with oral aspirin. The child showed dramatic response. He became afebrile and the inflammation of scrotal sacs subsided within 72 h. There are three similar case reports describing the association of KD with orchitis [1, 2, 3]. This case is a message that orchitis with erythema of the scrotal sac can be seen in KD. Awareness of this possibility will save many unnecessary surgical explorations. The desquamation of the overlying scrotal skin (Fig. 1) serves as an important clinical marker to differentiate KD-induced orchitis from other causes of orchitis or torsion of testis.
Fig. 1

Desquamation of the superficial skin of scrotum along with diffuse erythema

Notes

Compliance with Ethical Standards

Conflict of Interest

None.

Source of Funding

None.

References

  1. 1.
    Connolly KD, Timmons D. Epididymo-orchitis in Kawasaki disease. Arch Dis Child. 1979;54:728.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Jibiki T, Sakai T, Saitou T, et al. Acute scrotum in Kawasaki disease: two case reports and a literature review. Pediatr Int. 2013;55:771–5.CrossRefPubMedGoogle Scholar
  3. 3.
    Lim DL, Shek L, Lee BW, Quek SC. Epididymo-orchitis in a patient with atypical Kawasaki disease - the role of steroids. Pediatr Res. 2003;53:178.CrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2017

Authors and Affiliations

  1. 1.Department of PediatricsKSS HospitalKolkataIndia
  2. 2.Department of PediatricsInstitute of Child HealthKolkataIndia

Personalised recommendations