Hindawi Publishing Corporation Case Reports in Medicine Volume 2011, Article ID 606920, 4 pages doi:10.1155/2011/606920 Case Report Evidence of Acute Mycoplasma Infection in a Patient with Incomplete and Atypical Kawasaki Disease: A Case Report M. Ebrahim,1 M. Gabay,1, 2, 3 and R. F. Rivas-Chacon3 1 Miami Children’s Hospital, Miami, FL 33155, USA 2 Department of Pediatrics, Nova Southeastern University, Fort Lauderdale-Davie, FL 33314-7796, USA 3 Department of Rheumatology, University of Miami, Miami, FL 33136, USA Correspondence should be addressed to M. Ebrahim, mohdi84@gmail.com Received 30 August 2011; Revised 31 October 2011; Accepted 1 November 2011 Academic Editor: C. G. M. Kallenberg Copyright © 2011 M. Ebrahim et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The etiology of Kawasaki disease remains unknown despite extensive studies. Some researchers suggest that it is caused by an infectious agent. This is a case report where a patient with incomplete Kawasaki disease was found to have evidence compatible with acute Mycoplasma pneumoniae infection. This is one of the several case reports linking Mycoplasma pneumoniae to Kawasaki disease as a possible trigger. This is perhaps due to a superantigen or is mediated by some other mechanism. Accurate and timely testing for Mycoplasma infections is diﬃcult and has its limitations. Despite this, Mycoplasma pneumoniae should be considered in the diﬀerential and workup for Kawasaki disease. 1. Case A previously healthy, fully vaccinated 12-year-old Hispanic male presented with a 6-day history of high-grade and inter- mittent daily fever (up to 105◦F) upon admission. His initial symptoms were sore throat, nausea, and vomiting in addition to fever. Three days prior to admission, the patient was seen in a pediatric emergency department and discharged with a diagnosis of viral illness. The fever persisted, and he became more ill appearing with complaints of weakness, malaise, and myalgias, and a faint generalized, nonpruritic rash began to appear. There was no history of joint involvement, sick con- tacts, recent travel, or exposures other than a family dog. Physical examination at the time of admission revealed a tachycardic (heart rate of 118 beats/min), tachypneic (respi- ratory rate of 20/min), febrile (101.5◦F), ill-appearing patient with normal blood pressure (121/75). An erythematous mac- ular rash was present on the face, abdomen, and extremities. He had conjunctival injection and pharyngeal erythema without observed oral ulcers. Small bilateral cervical lym- phadenopathy were palpated and measured to be less than 1.5 cm in size. There was no associated edema, erythema, or desquamation of the hands or feet. Laboratory workup was initiated for suspected infecti- ous or rheumatologic causes. Abnormal laboratory ﬁnd- ings included a leukocytosis (17 × 103/mm3) with predom- inant neutrophils and a normocytic, normochromic ane- mia (12.2 mg/dL). Complete blood count showed an initial thrombocytopenia (143 × 103/mm3) that was later followed by thrombocytosis (398 × 103/mm3). In addition, analysis revealed an elevated CRP (14.2 mg/L), ESR (64 mm/h), and hypoalbuminemia (2.5 g/dL). Mycoplasma pneumoniae IgM serology was positive (Mycoplasma IgM titer ≥1.10). Chest X-ray showed faint bilateral interstitial markings without lung consolidation or collapse. Comprehensive viral studies and cultures from the throat, urine, and blood were negative. The remainder of the initial workup, which included elec- trolytes, urinalysis, renal function test, and lupus analyzer, was within normal range. A diagnosis of viral syndrome was initially suspected, although a course of azithromycin (10 mg/kg/day) was start- ed. Acute Mycoplasma pneumoniae infection was made after the Mycoplasma IgM serology came back positive. Subse- quently, the possibility of Incomplete Kawasaki disease was entertained given the patient’s presentation. This was later conﬁrmed on day 1 of hospitalization by an echocardiogram