A Case of Multiple Septic Arthritis by Streptococcus pneumoniae in Kawasaki Disease / 소아과

ABSTRACT

In Kawasaki disease, arthritis may occur, generally affecting the hands, knees, ankles, or hips. Operations have not usually been needed. We report a case of Kawasaki Disease with multiple septic arthritis which was caused by S. pneumoniae and which needed athrotomy with drainage for both hips, both knees, and both ankle joints. A two year, ten-month-old girl was admitted to our pediatric department. She had a high fever for four days, erythema of the oral and pharyngeal mucosa with a "strawberry" tongue and dry, cracked lips and scarlatiniform rash around the neck and in the groin area, perianal desquamation and a nonsuppurative left cervical lymphadenopathy. At first, we diagnosed her condition as typical Kawasaki disease, and treated her with intravenous immunoglobulin(IVIG) and aspirin. On the sixth admission day, arthralgia developed in both hip joints. She refused to bear weight on the both lower limbs and resisted all passive motion of the hip. An ultrasonogram of the both hip joints revealed an effusion, and four milliliters of grossly purulent material was aspirated from them. Gram staining of this material showed many leukocytes and Gram-positive diplococci. The finding was consistent with septic arthritis. An open arthrotomy of the hip was done and antibiotics prescribed. On the 7th admission day, the findings of multiple athritis were found including ultrasonogram, in both hips, both knees, both ankles, both shoulders, and both elbow joints as well as both wrist joints. The purulent material culture from the left hip and right knee joints' fluid revealed S. pneumoniae. On the 9th and 11th admission day, arthrostomy was performed on the both hips, both knees, and both ankle joints.