{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:11:40Z","timestamp":1792793500103,"version":"4.5.0"},"reference-count":21,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,11,2]]},"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2020-239648","type":"journal-article","created":{"date-parts":[[2023,3,14]],"date-time":"2023-03-14T00:15:25Z","timestamp":1678752925000},"page":"e239648","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Reactivation of BCG inoculation site in a child with febrile exanthema of 3 days duration: an early indicator of incomplete Kawasaki disease"],"prefix":"10.1136","volume":"13","author":[{"given":"Kimberley Ying Ying","family":"Lim","sequence":"first","affiliation":[{"name":"Paediatrics, National University Singapore Yong Loo Lin School of Medicine, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei Chien","family":"Chua","sequence":"additional","affiliation":[{"name":"Department of Neonatology, KK Women's and Children's Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie Woon Hui","family":"Tan","sequence":"additional","affiliation":[{"name":"Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5961-7441","authenticated-orcid":false,"given":"Suresh","family":"Chandran","sequence":"additional","affiliation":[{"name":"Neonatology, KK Women's and Children's Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,12,17]]},"reference":[{"key":"2025082623543993000_13.12.e239648.1","doi-asserted-by":"crossref","first-page":"155","DOI":"10.3947\/ic.2015.47.3.155","article-title":"Febrile illness with skin rashes","volume":"47","author":"Kang","year":"2015","journal-title":"Infect Chemother"},{"key":"2025082623543993000_13.12.e239648.2","doi-asserted-by":"crossref","DOI":"10.1186\/s12887-019-1695-0","article-title":"Kawasaki disease in infants less than one year of age: an Italian cohort from a single center","volume":"19","author":"Mastrangelo","year":"2019","journal-title":"BMC Pediatr"},{"key":"2025082623543993000_13.12.e239648.3","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000484"},{"key":"2025082623543993000_13.12.e239648.4","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e3181cacede"},{"key":"2025082623543993000_13.12.e239648.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12887-019-1635-z","article-title":"Measles infection causing Bacillus Calmette-Gu\u00e9rin reactivation: a case report","volume":"19","author":"Muthuvelu","year":"2019","journal-title":"BMC Pediatr"},{"key":"2025082623543993000_13.12.e239648.6","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2008-2187"},{"key":"2025082623543993000_13.12.e239648.7","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1542\/peds.95.4.475","article-title":"Epidemiologic pictures of Kawasaki disease in Japan: from the nationwide incidence survey in 1991 and 1992","volume":"95","author":"Yanagawa","year":"1995","journal-title":"Pediatrics"},{"key":"2025082623543993000_13.12.e239648.8","doi-asserted-by":"crossref","first-page":"292","DOI":"10.3345\/kjp.2019.00157","article-title":"Reality of Kawasaki disease epidemiology","volume":"62","author":"Kim","year":"2019","journal-title":"Korean J Pediatr"},{"key":"2025082623543993000_13.12.e239648.9","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1007\/s00246-012-0232-9","article-title":"Increased incidence of incomplete Kawasaki disease at a pediatric hospital after publication of the 2004 American heart association guidelines","volume":"33","author":"Ghelani","year":"2012","journal-title":"Pediatr Cardiol"},{"key":"2025082623543993000_13.12.e239648.10","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1111\/j.1651-2227.1994.tb12985.x","article-title":"Incidence and clinical features of incomplete Kawasaki disease","volume":"83","author":"Fukushige","year":"1994","journal-title":"Acta Paediatr"},{"key":"2025082623543993000_13.12.e239648.11","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-011-1631-2"},{"key":"2025082623543993000_13.12.e239648.12","doi-asserted-by":"crossref","unstructured":"Sundel RP , Petty RE . 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