Mucocutaneous lymph node syndrome. A case masquerading as Rocky Mountain spotted fever

Mucocutaneous lymph node syndrome is a recently described entity whose principal signs and symptoms include fever, unresponsiveness to antibiotics, congested conjunctivae, reddening of the oral cavity, lips, palms, and soles, exanthem, edema, nonsuppurative cervical adenitis, and desquamation of the fingertips. Almost 7,000 cases have been reported in Japan. Analysis of the 39 cases reported in the United States reveals findings similar to those in Japan. United States cases, however, have had a higher boy-to-girl ratio (2:1), and age distribution peaks at a later time (3 years of age). We report a case with many characteristics of Rocky Mountain spotted fever, including a positive Well-Felix reaction. Some cases of mucocutaneous lymph node syndrome may be misdiagnosed as Rocky Mountain spotted fever.