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Reactivation of BCG inoculation site in a child with febrile exanthema of 3 days duration: an early indicator of incomplete Kawasaki disease
  1. Kimberley Ying Ying Lim1,
  2. Mei Chien Chua2,
  3. Natalie Woon Hui Tan3 and
  4. Suresh Chandran4
  1. 1Paediatrics, National University Singapore Yong Loo Lin School of Medicine, Singapore
  2. 2Department of Neonatology, KK Women's and Children's Hospital, Singapore
  3. 3Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
  4. 4Neonatology, KK Women's and Children's Hospital, Singapore
  1. Correspondence to Professor Suresh Chandran; profschandran2019{at}


The aetiology of febrile exanthems in children is often difficult to distinguish clinically. A diagnosis of Kawasaki disease (KD) should be considered in infants with exanthematous fever. More perplexing is the increasing incidence of an atypical form of KD. Pathogenesis of KD remains unclear even though an aberrant response of the immune system to an unidentified pathogen is often hypothesised. A 30-fold increase in the incidence of KD in Italy during the SARS-CoV-2 pandemic suggests an immune response to a viral trigger. We report an infant clinically diagnosed with high probability as incomplete KD, who presented with reactivation of the BCG injection site even though fever with rash was only less than 3 days duration. Echocardiography confirmed coronary artery abnormalities and prompt treatment with intravenous immunoglobulin facilitated rapid recovery. Physicians should consider a diagnosis of KD if BCG site reactivation is noted in children presenting with febrile exanthema.

  • ischaemic heart disease
  • cardiovascular system
  • immunological products and vaccines
  • vaccination/immunisation
  • medical management

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  • Contributors KYYL and SC involved in manuscript preparation and review of literature. NWHT involved in manuscript preparation. MCC and SC contributed to review and editing the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.