Case Report

BCG Scar Reactivation as a Diagnostic Clue in Kawasaki Disease

Volume: 14 Number: 1 September 28, 2026
EN TR

BCG Scar Reactivation as a Diagnostic Clue in Kawasaki Disease

Abstract

Classic diagnosis of Kawasaki disease: fever lasting at least five days accompanied by erythema and cracking of the lips, strawberry tongue, and/or erythema of the oral mucosa; bilateral conjunctivitis without exudate; maculopapular rash, widespread erythroderma, or erythema multiforme-like rashes; erythema and edema of the hands and feet in the acute phase and/or periungual desquamation in the subacute phase; and the presence of at least four of the following findings: typically unilateral cervical lymphadenopathy (≥1.5 cm). However, diagnosing Kawasaki disease in infants can be challenging. In the presence of unexplained high fever, erythema developing at the Bacillus Calmette-Guérin (BCG) vaccination site should serve as a warning sign for physicians, even if typical clinical findings are not fully present. In our case, which was initially evaluated with a preliminary diagnosis of upper respiratory tract infection, Kawasaki disease was suspected based on the presence of a 3-day fever, bilateral non-purulent conjunctivitis, macular rash in the neck region, and lip erythema, along with erythema at the BCG scar. Given that the BCG vaccine is routinely administered at 2 months of age in our country, this case highlights that BCG reactivation is an important finding for the early diagnosis of infant Kawasaki disease.

Keywords

References

  1. Roh DE, Kwon JE, Kim YH. Bacille Calmette-Guérin Site Reactivation of Kawasaki Disease in Infants under 3 Months of Age: Relation with Diagnosis and Prognosis. Children (Basel). 2022;9(6):857.
  2. Houska N, Albertz M, Ing RJ. Update on Diagnosis and Management of Kawasaki Disease: A Scientific Statement From the American Heart Association. J Cardiothorac Vasc Anesth. 2025;39(5):1103-1105.
  3. Jone PN, Tremoulet A, Choueiter N, et al. Correction to: Update on Diagnosis and Management of Kawasaki Disease: A Scientific Statement From the American Heart Association. Circulation. 2025;151(13):e863.
  4. Asbik O, El Hachmi I, Elouali A, Rkain M, Babakhouya A. An Unexpected Diagnosis of Kawasaki Disease in a Three-Month-Old Infant: A Diagnostic Trap. Cureus. 2025;17(7):e87088.
  5. Rezai MS, Shahmohammadi S. Erythema at BCG Inoculation Site in Kawasaki Disease Patients. Mater Sociomed. 2014;26(4):256-60.
  6. Uehara R, Igarashi H, Yashiro M, Nakamura Y, Yanagawa H. Kawasaki disease patients with redness or crust formation at the Bacille Calmette-Guérin inoculation site. Pediatr Infect Dis J. 2010;29(5):430-3.
  7. Kobayashi T, Ayusawa M, Suzuki H, et al. Revision of diagnostic guidelines for Kawasaki disease (6th revised edition). Pediatr Int. 2020;62(10):1135-1138.
  8. Takayama J, Yanase Y, Kawasaki T. Study of the changes of the site of the BCG inoculation in MCLS (in Japanese). Jpn J Pediatr 1982;86: 567-572.

Details

Primary Language

English

Subjects

Pediatric Infectious Diseases

Journal Section

Case Report

Publication Date

September 28, 2026

Submission Date

April 23, 2026

Acceptance Date

September 11, 2026

Published in Issue

Year 2026 Volume: 14 Number: 1

APA
Çetin, C., Çetin, F. T., Bulut, M., & Turan, C. (2026). BCG Scar Reactivation as a Diagnostic Clue in Kawasaki Disease. Pediatric Practice and Research, 14(1), 1936353. https://doi.org/10.21765/pprjournal.1936353
AMA
1.Çetin C, Çetin FT, Bulut M, Turan C. BCG Scar Reactivation as a Diagnostic Clue in Kawasaki Disease. pediatr pract res. 2026;14(1):1936353. doi:10.21765/pprjournal.1936353
Chicago
Çetin, Cansu, Fatma Tuğba Çetin, Muhammet Bulut, and Cansu Turan. 2026. “BCG Scar Reactivation As a Diagnostic Clue in Kawasaki Disease”. Pediatric Practice and Research 14 (1): 1936353. https://doi.org/10.21765/pprjournal.1936353.
EndNote
Çetin C, Çetin FT, Bulut M, Turan C (September 1, 2026) BCG Scar Reactivation as a Diagnostic Clue in Kawasaki Disease. Pediatric Practice and Research 14 1 1936353.
IEEE
[1]C. Çetin, F. T. Çetin, M. Bulut, and C. Turan, “BCG Scar Reactivation as a Diagnostic Clue in Kawasaki Disease”, pediatr pract res, vol. 14, no. 1, p. 1936353, Sept. 2026, doi: 10.21765/pprjournal.1936353.
ISNAD
Çetin, Cansu - Çetin, Fatma Tuğba - Bulut, Muhammet - Turan, Cansu. “BCG Scar Reactivation As a Diagnostic Clue in Kawasaki Disease”. Pediatric Practice and Research 14/1 (September 1, 2026): 1936353. https://doi.org/10.21765/pprjournal.1936353.
JAMA
1.Çetin C, Çetin FT, Bulut M, Turan C. BCG Scar Reactivation as a Diagnostic Clue in Kawasaki Disease. pediatr pract res. 2026;14:1936353.
MLA
Çetin, Cansu, et al. “BCG Scar Reactivation As a Diagnostic Clue in Kawasaki Disease”. Pediatric Practice and Research, vol. 14, no. 1, Sept. 2026, p. 1936353, doi:10.21765/pprjournal.1936353.
Vancouver
1.Cansu Çetin, Fatma Tuğba Çetin, Muhammet Bulut, Cansu Turan. BCG Scar Reactivation as a Diagnostic Clue in Kawasaki Disease. pediatr pract res. 2026 Sep. 1;14(1):1936353. doi:10.21765/pprjournal.1936353