Yersinia pseudotuberculosis infection with erythema nodosum satisfying the criterion for Kawasaki disease

A 6-year-old girl was hospitalized in the pediatric ward due to painful erythema and fever, and was then referred to our department for evaluation of the eruptions. A biopsy from a painful erythema of the leg showed septal panniculitis and was diagnosed as erythema nodosum. The symptoms fulfilled the criterion for Kawasaki disease, and treatment with immunoglobulin and aspirin was started. The fever went down rapidly, and the eruptions improved. Her general condition has not worsened, and an echocardiogram showed no tendency to dilation of coronary arteries. She was discharged from the hospital on the 35th day. Aside from the symptoms simulating Kawasaki disease, the abdominal symptoms, erythema nodosum and a history of drinking well water suggested Yersinia infection. Although stool cultures were negative, antibody titers for Yersinia pseudotuberculosis 4b were elevated, and she was diagnosed as Y. pseudotuberculosis infection showing erythema nodosum and symptoms seen in Kawasaki disease.