Sir.—We read with interest the article by Krowchuk et al in the January 1990 issue of AJDC.1 The authors presented a child with purported Kawasaki syndrome who had the unusual, early finding of thrombocytopenia. It must be reiterated, however, that this is a syndrome whose diagnosis is clinical, supported by nonspecific laboratory data.2 Because the cause remains obscure, other diagnoses must be sought and excluded. Although no bacterial pathogens were isolated from this patient, leptospiral cultures were not obtained and serologic studies were not performed. The child's clinical, laboratory, and roentgenographic features, including hydrops of the gallbladder, were all compatible with the diagnosis of leptospirosis.3 Furthermore, thrombocytopenia is a common finding in leptospirosis, even without concurrent disseminated intravascular coagulation.4,5
BARTON LL, FRIEDMAN AD. The Platelet Count in Kawasaki Syndrome. Am J Dis Child. 1990;144(6):617–618. doi:10.1001/archpedi.1990.02150300011003
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