中毒性表皮坏死松解症误诊为川崎病临床分析并文献回顾OA

Objective To analyze the clinical characteristics and key points of differential diagnosis between Stevens-Johnson syndrome(SJS)/toxic epidermal necrolysis(TEN)and Kawasaki disease(KD),and to summarize the causes of misdiagnosis and preventive measures.Methods A retrospective analysis was conducted on the clinical data of a child admitted to Hebei General Hospital in September 2025 who was misdiagnosed with KD but had TEN combined with bronchopneumonia and mycoplasma pneumonia.The two diseases were compared and analyzed based on relevant literature.Results This 12-year-old male patient who was misdiagnosed as having KD at another hospital due to fever,conjunctival congestion in both eyes,red and peeling lips,oral mucosal ulcers,and multiple skin rashes all over the body.After receiving relevant treatment,the symptoms did not improve,so he was referred to our hospital for further treatment.Based on key features of a definite medication history,rapid progression of epidermal detachment,severe mucosal erosion t multiple sites,positive Nikolsky's sign,absence of superficial lymphadenopathy,chest CT findings,and absence of coronary artery dilation,he was diagnosed with TEN combined with bronchopneumonia and Mycoplasma pneumonia infection.The misdiagnosis period was 4 d.After comprehensive treatment including Methylprednisolone Sodium Succinate pulse therapy,intravenous injection of human immunoglobulin,anti-infection,and care for multiple wounds and mucous membranes,the patient recovered and was discharged.Conclusion Both SJS/TEN and KD can present with fever,mucosal involvement,and rash in the early stages,with highly overlapping clinical manifestations,easily leading to misdiagnosis.Detailed medication history,dynamic observation of the progression of skin and mucosal lesions,and attention to symptoms and signs such as Nikolsky's sign,superficial lymph node involvement,and coronary artery involvement are crucial to reducing misdiagnosis and avoiding delays in treatment.