Our patient displayed sufficient clinical findings to enable a diagnosis of KD. These criteria are; (1) a fever of more than 5 days duration, (2) skin changes at the extremities, including erythema on palms and soles, (3) polymorphous skin rashes, (4) bilateral conjunctival injections, (5) changes in oral mucosa, reddening of lips, and a 'strawberry' tongue, and (6) cervical lymphadenopathy10
. To enable a diagnosis of classic KD, the presence of a fever for more than 5 days and at least 4 of the above five principal criteria are required. As demonstrated by the above criteria, skin changes are important features of KD. Many morphological skin changes have been reported in the literature, such as, scarlatiniform or morbilliform exanthema, generalized erythema, erythema marginatum, erythema multiforme11
, psoriatic eruptions7
, and palmoplantar pustular eruptions12
Skin changes in the extremities are known to be distinctive. During the acute phase of KD, erythema of the palms and soles or firm and sometimes painful indurations of hands or feet, or both can occur. Within 2 to 3 weeks after the onset of fever, desquamation of the fingers or toes usually starts in periungual regions and may spread to the palms or soles. Nail changes, such as, deep transverse grooves across nails (Beau's lines) may occur at 1 to 2 months after fever onset. On the other hand, erythematous rashes appear within 5 days of fever onset, and consist mostly of diffuse maculopapular eruptions, urticarial exanthems, scarlatiniform rashes, erythroderma, or occasionally erythema-multiforme-like rashes, which usually involve extensive areas of the trunk and extremities. Furthermore, these rashes are known to be accentuated in perineal regions, where early desquamation may also occur6
In the present case, desquamative skin lesions had developed on the palms, soles, and perineal regions at the time of diagnosis of KD (on admission). About one week later, depigmented lesions occurred on previous desquamative areas during the KD convalescent phase. Vitiligo is known to be associated with many diseases. However, to the best of our knowledge, no previous report has associated vitiligo and KD. The nature of this association is unclear, in particular, it is not known whether there is a cause and effect relation or whether the two were coincidental in our patient. Nevertheless, the etiologies of both diseases are believed to have an immunologic basis. Thus, the co-occurrence of the two in our patient suggests that vitiligo and KD are immunologically associated.