Recurrent kawasaki disease with strawberry tongue and skin desquamation in a young adult

A 19-year-old man with history of Kawasaki disease (KD) at age 12 developed intractable fevers, swelling in hands and feet, arthralgias, and conjunctivitis, followed by strawberry tongue and desquamation of distal extremities. Laboratory studies revealed leukocytosis, thrombocytosis, anemia, elevated erythrocyte sedimentation rate and C-reactive protein levels, and mildly elevated liver enzymes. He was empirically treated with broad-spectrum antibiotics without any improvement. Extensive infectious and rheumatologic workup remained negative. Recurrence of KD was diagnosed based on characteristic mucocutaneous changes and systemic inflammatory response. His symptoms and laboratory values responded rapidly to intravenous immunoglobulin and aspirin therapy. An echocardiogram did not show any coronary abnormality. We report the third case of pediatric KD relapsing in adulthood. Similar to childhood and adult KD, these recurrent episodes respond well to intravenous immunoglobulin therapy. Although recurrent KD is rare, our case highlights the importance of considering it in the differential of febrile illness in the appropriate individual.