Kawasaki disease Masquerading as Suppurative BCG Lymphadenitis

Background: Kawasaki disease (KD) is an acute medium-vessel vasculitis of childhood that frequently mimics infectious illnesses. Reactivation of the Bacillus Calmette–Guérin (BCG) vaccination site is a recognized complication of Kawasaki disease. We present a case of Kawasaki disease which presented with flared suppurative BCG lymphadenitis  along with flare up of BCG vaccination site consistent with BCG reactivation.

Clinical Description: An 8-month-old male infant presented with prolonged fever, unilateral cervical lymphadenopathy, and a suppurative right axillary lymph node adjacent to the BCG vaccination site. He was initially managed as bacterial lymphadenitis. Microbiological evaluation of aspirated pus revealed Mycobacterium tuberculosis complex, later confirmed as Mycobacterium bovis. Despite appropriate antimicrobial therapy, fever persisted, and the child subsequently developed mucocutaneous features suggestive of Kawasaki disease.

Management and Outcome: A diagnosis of Kawasaki disease with suppurative BCG lymphadenitis was made. The child was treated with intravenous immunoglobulin, aspirin, and adjunctive corticosteroids owing to high-risk features. Fever subsided promptly following therapy. Serial echocardiography showed coronary artery dimensions at the upper limits of normal initially, with subsequent normalization. The child recovered without coronary sequelae.

Conclusion: This case highlights suppurative BCG lymphadenitis as a diagnostic pitfall in Kawasaki disease and emphasizes the need to consider KD in infants with persistent fever and lymphadenitis unresponsive to antibiotics in BCG-vaccinated populations.

Keywords: Kawasaki disease, BCG reactivation, lymphadenitis, Mycobacterium bovis, infant

Dr. G. Manisha Varma presently working as Assistant professor in the department of Paediatrics , All india institute of medical sciences, Bibinagar, Telangana has graduated in the year 2014 and has persuaded her Diploma at national board at Rainbow childrens hospital, Hyderabad, Telangana in the year 2019. With over 6 years of experience in Paediatrics, she has several national and international publications. She has won several awards in the quiz and poster/paper presentations in various conferences. She is an instructor for Basic NRP, Advanced NRP, BLS and PALS programs . Her special interests are pediatric hemato oncology and pediatric endocrinology.