In Reply.—We appreciate the thoughtful comments of Drs Barton and Friedman suggesting the possibility that the child described by us1 may have suffered from leptospirosis rather than Kawasaki disease. As they noted, establishing a diagnosis of Kawasaki disease rests on both the observation of typical clinical manifestations and the exclusion of other processes that might produce similar symptoms and signs. Among the many conditions appropriately included in the differential diagnosis of Kawasaki disease is leptospirosis.
Leptospirosis is a systemic infection characterized by a widespread vasculitis and may share with Kawasaki disease a number of the clinical and laboratory features observed in our patient, including fever, diarrhea, vomiting, rash, conjunctival and pharyngeal injection, thrombocytopenia, and hydrops of the gallbladder.2,3 While it is not possible to exclude, with certainty, a diagnosis of leptospirosis in the child described by us, several aspects of her illness were unique to Kawasaki disease and lent
KUMAR ML, VIELHABER MM, DANISH EH. The Platelet Count in Kawasaki Syndrome-Reply. Am J Dis Child. 1990;144(6):618. doi:10.1001/archpedi.1990.02150300012004