Mucocutaneous lymph node syndrome in an adult, with lymph node biopsy correlation.

We have described a 34-year-old woman with an acute illness that meets the clinical criteria for the diagnosis of Kawasaki disease (mucocutaneous lymph node syndrome). Striking histopathologic changes found in an anterior cervical lymph node were multifocal acute necrosis and fibrin thrombi occluding small blood vessels. Biopsy of a cervical lymph node can be helpful in ruling out certain disease entities with similar clinical features.

Indolent meningococcal meningitis: a cautionary tale.

Bacterial meningitis is a medical emergency that is ordinarily rapidly progressive. We present three patients who had meningococcal meningitis with an indolent course. Symptoms were present from two days to four weeks before hospitalization. Cerebrospinal fluid cultures grew Neisseria meningitidis one to eight days before antibiotic therapy, yet all patients remained fully alert and clinically stable during this interval. All recovered after penicillin therapy. In the future earlier diagnosis should be facilitated by an awareness of differing manifestations of meningococcal meningitis, including benign CSF findings, intact sensorium, and an indolent progression. Immunologic studies will be required to clarify the pathogenesis of this syndrome.

Kawasaki syndrome: description of two outbreaks in the United States.

Investigation of two outbreaks of Kawasaki syndrome (KS) in the United States in 1979 and in 1980 revealed no evidence of person-to-person transmission or of a common-source exposure among patients. Questionnaire data showed that KS was more likely to occur in children of middle and upper socioeconomic status than in those of lower status (P less than 0.05 and P less than 0.001 for the respective outbreaks) and that patients with KS had a higher incidence of an antecedent, primarily respiratory illness than did controls matched for age, sex, and race (83% of patients in the first outbreak vs. 30% of one control group, P less than 0.01, and vs. 36% of another control group, P less than 0.02; and 56% of patients in the second outbreak vs. 32% of their controls, P less than 0.02). However, laboratory studies did not identify an etiologic agent for either KS or for the antecedent illness that may be a risk factor for KS.

Fulminant neonatal meningococcemia.

Neisseria meningitidis is a rare cause of infection in infants younger than 2 months of age, presumably because of transplacental passage of protective maternal antibodies. In most reported cases of meningococcal disease in neonates, a relatively mild clinical course has been observed. A 25-day-old infant survived acute, severe meningococcemia due to group B N meningitidis. This organism should be considered when neonates have signs of septicemia, especially in the presence of cutaneous petechiae and purpura.

Early diagnosis of disc-space infection using Gallium-67.

A 4-year-old boy had had progressive central lumbar pain and hamstring spasm. He had a normal lumbar-spine x-ray except for minimal L-5, S1 spondylolysis, but gave an abnormal gallium-67 scan in the region of the low lumbar spine. Eight weeks following intensive antibiotic therapy, confirmation of the diagnosis of disc-space infection was established by roentgenographic studies that demonstrated narrowing of the L 4-5 intervertebral disc space. A technetium-99m diphosphonate bone scan, performed concurrently with the gallium-67 study, was normal.