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Mucocutaneous lymph node syndrome in two siblings.

Case 1-A 2-year-old Jamaican girl developed a fever, followed the next day by a generalised erythematous rash, which lasted for three days without desquamation. She then developed diarrhoea and vomiting, and on the sixth day became drowsy and was admitted to hospital. She was febrile (39 3 C); her lips and throat were strikingly red; and she had bilateral conjunctivitis. She had generalised lymphadenopathy, indurative oedema of her fingers and toes, neck stiffness, and a negative Kernig's sign. On the eleventh day a systolic murmur varying from ejection to pansystolic was heard, followed by a pericardial friction rub the next day, and her liver became palpable. On the eighteenth day her fever subsided and she improved considerably. Lumbar puncture produced normal results. Urine analysis showed a moderate amount of blood, with 15 x 106 white cells/l. An electrocardiogram taken at the time of the pericardial friction rub showed slight elevation of the ST segment in all the leads. A chest x-ray film and the results of echocardiography were normal. The serum complement C3 concentration was 0 7 g/l (normal 0-7-1 7), C4 was 0-2 g/l (normal 0 1-0-7). No antinuclear factor was detected, and lupus erythematosus cells were not present (see the table for the results of other investigations).