Sex: M
Vaccine: HEPA
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, C-reactive protein, Cellulitis, Eosinophil count increased
Clinical narrative: incomplete Kawasaki disease (KD); fever; rash/ skin eruption; pruritic on his extremities; blanchable eruption on his extremities; pink papular eruption on his extremities; erythematous edematous plaque on the right calf/ erythema; erythematous, desquamating patches of the groin, perineum, and buttocks; tachycardic; positive human herpesvirus-6 polymerase chain reaction; desquamation in the axillae, bilateral inguinal folds, and gluteal cleft; feet were erythematous and edematous/ edema of the feet; thrombocytosis; cellulitis-like plaque on the right calf; peripheral eosinophilia; cellulitis-like plaque on the right calf; This serious case was reported in a literature article and described the occurrence of kawasaki's disease in a 7-year-old male patient who received Hepatitis A vaccine for prophylaxis.   On an unknown date, the patient received the 1st dose of Hepatitis A vaccine. On an unknown date, an unknown time after receiving Hepatitis A vaccine, the patient experienced kawasaki's disease (Verbatim: incomplete Kawasaki disease (KD)) (serious criteria hospitalization and GSK medically significant), fever (Verbatim: fever) (serious criteria hospitalization), skin eruption (Verbatim: rash/ skin eruption) (serious criteria hospitalization), pruritus (Verbatim: pruritic on his extremities) (serious criteria hospitalization), blanching (Verbatim: blanchable eruption on his extremities) (serious criteria hospitalization), papular skin eruption (Verbatim: pink papular eruption on his extremities) (serious criteria hospitalization), erythema edematous (Verbatim: erythematous edematous plaque on the right calf/ erythema) (serious criteria hospitalization), rash desquamating (Verbatim: erythematous, desquamating patches of the groin, perineum, and buttocks) (serious criteria hospitalization), tachycardia (Verbatim: tachycardic) (serious criteria hospitalization), human herpesvirus 6 infection (Verbatim: positive human herpesvirus-6 polymerase chain reaction) (serious criteria hospitalization), desquamation (Verbatim: desquamation in the axillae, bilateral inguinal folds, and gluteal cleft) (serious criteria hospitalization), pedal edema (Verbatim: feet were erythematous and edematous/ edema of the feet) (serious criteria hospitalization), thrombocytosis (Verbatim: thrombocytosis) (serious criteria hospitalization), cellulitis (Verbatim: cellulitis-like plaque on the right calf) (serious criteria hospitalization), eosinophilia (Verbatim: peripheral eosinophilia) (serious criteria hospitalization) and skin plaque (Verbatim: cellulitis-like plaque on the right calf) (serious criteria hospitalization). The patient was treated with immunoglobulin human normal (Immunoglobulin) and acetylsalicylic acid (Aspirin). The outcome of the kawasaki's disease, pruritus, blanching, papular skin eruption, erythema edematous, rash desquamating, tachycardia, human herpesvirus 6 infection, desquamation, pedal edema, thrombocytosis, cellulitis, eosinophilia and skin plaque were not reported and the outcome of the fever and skin eruption were resolved.   The reporter considered the kawasaki's disease, fever, skin eruption, pruritus, blanching, papular skin eruption, erythema edematous, rash desquamating, tachycardia, human herpesvirus 6 infection, desquamation, pedal edema, thrombocytosis, cellulitis, eosinophilia and skin plaque to be related to Hepatitis A vaccine.     The company considered the kawasaki's disease, fever, skin eruption, pruritus, blanching, papular skin eruption, erythema edematous, rash desquamating, tachycardia, human herpesvirus 6 infection, desquamation, pedal edema, thrombocytosis, cellulitis, eosinophilia and skin plaque to be related to Hepatitis A vaccine.   Additional Information: GSK received date: 22-Jan-2024  A healthy 7-year-old boy presented to the emergency department (ED) with 10 days of fever and rash that began 3 days after receiving his first dose of hepatitis A vaccine. He initially developed a pruritic, blanchable, and pink papular eruption on his extremities, an erythematous edematous plaque on the right calf and fevers to 38.6 degree C. The eruption evolved to include erythematous, desquamating patches of the groin, perineum, and buttocks, which spread to the abdomen, trunk, and axillae. In the ED, he was afebrile, tachycardic, and labs were notable for an elevated white blood cell count to 14.1 109/L with an absolute eosinophil count of 1120/uL, hemoglobin of 11.9 g/dL, platelets of 508 109/L, elevated acute-phase reactants and transaminases (Creactive protein (CRP) 5.4, erythrocyte sedimentation rate (ESR) 97 mm/h, alanine transaminase (ALT) 57, aspartate transaminase (AST 51), a positive human herpesvirus-6 polymerase chain reaction (HHV-6 PCR) and a negative test for Streptococcus pyogenes from an outside ED. He was admitted for evaluation of Kawasaki disease (KD). Skin examination was notable for mild erythema and desquamation in the axillae, bilateral inguinal folds, and gluteal cleft. Desquamation of the fingers and toes was observed, and the feet were erythematous and edematous. A single desquamating, indurated, and erythematous plaque was noted on the right lower calf. There was no evidence of lip swelling, conjunctivitis, erythema of the tongue, or palpable cervical lymphadenopathy. The prolonged length of fever, skin eruption, erythema and edema of the feet, thrombocytosis, and laboratory abnormalities (elevated ESR/CRP, and transaminitis), his presentation was characterized as incomplete KD with atypical features. His two most atypical features included the cellulitis-like plaque on the right calf and a peripheral eosinophilia. Administration of intravenous immunoglobulin and aspirin led to prompt and dramatic normalization of his fever, rash, and laboratory markers.  Authors presented a case of incomplete KD with atypical features, most notably a cellulitis-like rash and peripheral eosinophilia. The antecedent use of hepatitis A vaccine was a trigger for KD was debatable.