SHM Converge Scientific Abstract ePoster Gallery-More Than Skin Deep: A Challenging Case of Inguinal Cellulitis

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A previously healthy 4-year-old boy presented with lower abdominal pain and was found on CT to have mild left external iliac and inguinal lymphadenopathy. He soon developed fever and a tender, erythematous patch over the left inguinal region and was diagnosed with cellulitis. Despite treatment with multiple antibiotics, including trimethoprim-sulfamethoxazole, clindamycin, ampicillin-sulbactam, azithromycin, piperacillin-tazobactam, and vancomycin, his erythema rapidly progressed without improvement. He later developed dry cracked lips, bilateral conjunctival injection, and a maculopapular rash on the knees, thighs, and chest.<br /><br />Because of the prolonged fever and evolving symptom pattern, clinicians suspected incomplete Kawasaki disease. Echocardiography showed mild mitral and tricuspid regurgitation. Antibiotics were stopped, and the patient received IVIG at 2 g/kg plus moderate-dose aspirin. His fever resolved, laboratory values normalized, and he was discharged on low-dose aspirin. At 2-week follow-up, all symptoms had fully resolved.<br /><br />This case highlights that Kawasaki disease can present atypically and may mimic localized cellulitis. Inguinal cellulitis is a rare presentation, and this report is believed to be only the third such case described. The initial localized warmth, tenderness, swelling, and fever strongly suggested infection, and the rapid spread of erythema raised concern for necrotizing fasciitis, which imaging did not confirm. The later appearance of classic Kawasaki-type mucocutaneous findings helped establish the diagnosis.<br /><br />The case emphasizes the importance of considering Kawasaki disease in children with cellulitis-like findings that do not respond as expected to antibiotics, since prompt treatment within 10 days of fever onset reduces the risk of coronary artery aneurysms and other complications.

Asset Subtitle

Goutam Gutta

Meta Tag

Author List Andrea Newman-Molina, Goutam Gutta, Goutam Gutta, Guliz Erdem, Joshua Watson, Rebecca Wallihan

Category Clinical Vignettes

Concept Kawasaki Disease

Concept Incomplete Kawasaki Disease

Concept Intravenous Immunoglobulin

Concept Cellulitis

Concept Persistent Fever

Distinguished Non-Finalist

Presenter Organization The Ohio State University College of Medicine

Presenting Author Goutam Gutta

Track Pediatric

Keywords

Kawasaki disease

incomplete Kawasaki disease

cellulitis

inguinal cellulitis

fever

conjunctival injection

maculopapular rash

IVIG

aspirin

coronary artery aneurysm

Kawasaki Disease

Incomplete Kawasaki Disease

Intravenous Immunoglobulin

Cellulitis

Persistent Fever