Bacillus Calmette-Guérin scar reactivation (BCGitis) in Kawasaki disease. A Scoping Review

Bacillus Calmette-Guérin scar reactivation (BCGitis) in Kawasaki disease. 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A Scoping Review View ORCID Profile Hassib Narchi , View ORCID Profile Alyson Skinner doi: https://doi.org/10.1101/2025.10.03.25337219 Hassib Narchi 1 Department of Paediatrics, College of Medicine and Health Sciences, United Arab Emirates University , Al Ain, PO Box 15551, United Arab Emirates , ☏: +971 37137414 Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Hassib Narchi For correspondence: hassib.narchi{at}uaeu.ac.ae Alyson Skinner 2 (Retired) formerly Department of Paediatrics, Walsall Manor Hospital , Moat Road, Walsall, West Midlands, United Kingdom . ☏: +44 7968486323 Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Alyson Skinner Abstract Full Text Info/History Metrics Supplementary material Data/Code Preview PDF ABSTRACT Aim To map and synthesise the evidence on the scattered and heterogeneous reported prevalence of Bacillus Calmette-Guérin scar reactivation (BCGitis) in Kawasaki disease (KD), examine clinical associations, and identify knowledge gaps for future research. Methods A scoping review was conducted in accordance with PRISMA-ScR guidelines. PubMed, Scopus, EMBASE, Web of Science, and Cochrane Library were searched for observational studies of BCG-vaccinated children with KD. We retrieved the prevalence of BCGitis and its associations with age, sex, KD form, BCG vaccine strain, coronary artery abnormalities (CAA), and treatment response. Results Fifteen studies from five Asian countries (Japan, Korea, Taiwan, China, Singapore), including 21,880 children with KD, were identified. The reported prevalence of BCGitis ranged from 3.5% to 75.2% (overall prevalence 40.1%, 95% CI 39.6–40.6), with a higher prevalence in younger children. It was associated with lower CAA rates (11.8% vs 13.8%) but showed no significant association with KD type, vaccine strain, or treatment response. Conclusion BCGitis is a common manifestation of KD in BCG-vaccinated children and may have diagnostic and prognostic value, particularly in younger children and those with incomplete presentations. 1. INTRODUCTION Early diagnosis and treatment of Kawasaki disease (KD) are essential for preventing the development of coronary artery abnormalities (CAA). 1 , 2 Diagnosis remains primarily clinical. 3 , 4 Incomplete presentations, difficult to diagnose, are more prevalent in infants in whom CAA are more common. 2 , 4 – 8 The absence of pathognomonic biomarkers necessitates the inclusion of other clinical indicators to facilitate timely diagnosis and treatment. Scar reactivation at the Bacillus Calmette-Guérin (BCG) vaccination site is also known as “BCGitis”. It may occur as an early sign of KD in countries with universal BCG vaccination programs. 5 , 8 – 11 It has been included in the Japanese KD diagnostic guidelines in 2019 and is also used in Korea. 6 , 12 , 13 There is heterogeneity of the BCGitis prevalence rates in the reported studies, ranging from 70%. This reflects differences in research methodologies, healthcare systems, population characteristics, BCG vaccination programs, vaccine strains used, and inconsistent clinical assessment for BCGitis. Evidence-based diagnostic standards and clinical decision-making algorithms depend on precise prevalence data, identifying clinical factors and responses to treatment associated with BCGitis. This could improve risk stratification and targeted assessment strategies. Consolidating all such information in a “one-stop” resource is the aim of this scoping review. The intent is to map the extent of available evidence, highlight knowledge gaps and guide future research. 2. METHODS This scoping review followed the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) (Supplementary File 6). 2.1 Information Sources Five electronic databases were searched: PubMed, Scopus, EMBASE, Web of Science Core Collection, and Cochrane Library. Reference lists in retrieved studies were hand-searched. Grey literature was not included, as the focus was on peer-reviewed evidence. 2.2 Search Strategy The search was based on the Population, Concept, Context (PCC) framework. The Population consisted of children (<18 years) with KD. The Concept was: BCG scar reactivation/ erythema/ induration/ suppuration (“BCGitis”). The Context was: any clinical setting or country. Search strategies are provided in Supplementary File 4. 2.3 Inclusion Criteria Original observational studies (cohort, cross-sectional, case-control) Children (<18 years) with KD, hospital- or clinic-based BCG-vaccinated children, or studies providing separate data for vaccinated subgroups Systematic assessment of BCG vaccination sites Published in English, full-text available, without date or geographic restrictions 2.4 Exclusion Criteria Case reports, case series, reviews, editorials, or commentaries Overlap of patients among studies Unknown or unverified BCG vaccination status Incidental finding of BCGitis without systematic assessment Animal or experimental studies 2.5 Study Selection Two reviewers (HN and AS) independently screened titles and abstracts. Duplicates were removed, and potentially eligible studies underwent full-text review. Disagreements were resolved by consensus. Reasons for exclusion were recorded. 2.6 Data Extraction Data extraction was performed independently by two reviewers using a standardised form (Supplementary File 5). Discrepancies were resolved by discussion and re-checking the original reports. Authors were not contacted for missing data, consistent with scoping review methodology 2.7 Data Charting Subgroup analyses were conducted for age groups, sex, BCG vaccination strain, KD form, and CAA development. We also compared BCGitis prevalence with other KD diagnostic features, treatment response, and analysed its timing in the course of KD. 2.8 Synthesis of Results Consistent with scoping review methodology, data synthesis and results were primarily descriptive and narrative rather than statistical and meta-analytical. Prevalence estimates were calculated where appropriate. 2.9 Quality Assessment Formal quality assessment or evaluation of risk of bias analysis are not required for a scoping review. 14 3. RESULTS 3.1 Description of Included Studies The search identified 577 records (PubMed: 204, Scopus: 323, EMBASE: 23, Web of Science: 6, Cochrane Library: 21). After removing 432 duplicates, 145 studies were screened by title and abstract. Of these, 75 were excluded as irrelevant. Full-text review was performed for 70 studies, of which 55 were excluded: no systematic BCGitis assessment (n=11), unknown vaccination status (n=6), case reports (n=13), reviews (n=7), overlapping reported populations (n=1), non-English language (n=3), conference abstracts (n=2), and editorials/commentaries/letters (n=4). Fifteen studies met all criteria and were included. The selection process is shown in the PRISMA flow diagram ( Fig. 1 ). No additional studies were identified from reference lists. Download figure Open in new tab Figure 1. Flow diagram of selected studies The 15 studies were published between 1993 and 2023. They included 21,880 children with KD, of whom 8,781 (40%) had BCGitis. They originated from Japan (n=3), Korea (n=5), Taiwan (n=4), China (n=2), and Singapore (n=1). Fourteen studies (93%) were published after 2010, reflecting increasing recognition of BCGitis. Twelve were retrospective observational studies, two were case-control, and one was a clinical immunology study. All were hospital- or clinic-based ( Tables 1 and 2 ).. All participants were BCG-vaccinated as per national policy or with vaccination status verified individually, though documentation methods varied. View this table: View inline View popup Table 1. Characteristics of 15 included studies of 211,880 children with KD View this table: View inline View popup Table 2. Characteristics of 15 studies, in chronological order, including 21,880 children with KD with reported BCGitis prevalence 3.2 Overall BCGitis prevalence The prevalence ( Table 2 ) varied from 3.5% (China) to 75.2% (Korea). The overall prevalence was 40.1% (95% confidence intervals 39.6, 40.6). The median prevalence was highest in Japan (43.9%, range 43.9–72.2) and Korea (37.5%, range 16.9–75.2), intermediate in Taiwan (28.5%, range 25.3–49.0), and Singapore 42.7%. It was the lowest in China (7.4%, range 3.5–11.3). 3.3 BCGitis prevalence by age Nine studies (60%) reported age-stratified data. All showed higher prevalence in younger children. Among those 2 years, it ranged from 0% to 63.0%. Two studies found no BCGitis in children >5 years. The largest analysis by Takikawa (n=17,181) showed a prevalence of 61.8% in children <2 years versus 9.1% in ≥2 years (Supplementary file: Table 1 A). 3.4 BCGitis prevalence by sex Four studies (27%) reported sex-specific data, two of which three showed slightly higher rates in males. The overall prevalence was 46.4% in males versus 41.9% in females (Supplementary file: Table 1 B). 3.5 Prevalence of BCGitis and KD signs between KD forms 3.5.1 Complete vs incomplete Kawasaki disease Three studies compared the prevalence of BCGitis between KD forms. Two reported a higher prevalence in complete KD (44.1% vs 43.0%; 31.8% vs 13.0%), while one found a higher prevalence in incomplete KD (87.2% vs 71.7%). The overall prevalence was nearly identical between the two forms (44.6% vs 44.3%) ( Table 3 A). View this table: View inline View popup Table 3. Prevalence of BCGitis and KD clinical manifestations by KD forms 3.5.2 Comparison with other KD signs Seven studies compared BCGitis with other KD signs ( Table 3 B). Its prevalence (3.5– 70.8%) was lower than most other signs, but occasionally exceeded lymphadenopathy, particularly in younger children (<1 year: 43.5% vs 29% and <6 months: 18.4% vs 14.3%) ( Table 3 C). Comparing complete with incomplete KD forms ( Table 3 D), one study by Seo demonstrated that BCGitis was less frequent in complete than in incomplete KD, while the second study by Bae only analysed incomplete forms. However, in both studies, the prevalence of BCGitis exceeded that of lymphadenopathy and rash. 3.6 BCG vaccination 3.6.1 Interval between BCGitis and BCG vaccination Limited data were available. One study reported intervals of 30–806 days. Children with BCGitis had significantly shorter vaccination-to-symptom intervals (hazard ratio 0.995, 95% CI 0.993–0.997, p<0.001) (Supplementary file: Table 2 A). 3.6.2 BCGitis prevalence by BCG vaccine strain Eleven studies (73%) included patients vaccinated with Tokyo 172-1 (n=5), Pasteur 1173- P2 (n=3), Danish SSI-1331 (n=1), and Chinese substrains of Danish (n=2). The prevalence of BCGitis was 42.7–43.6% for Tokyo, Pasteur, and Danish strains, but much lower for Chinese substrains (5.2%) (Supplementary file: Table 2 B). 3.7 Response to therapy by BCGitis status Three studies (n=17,742) assessed the response to intravenous immunoglobulin (IVIG) administration. No significant differences were found between children with and without BCGitis (59.0% vs 57.2%) ( Table 4 ). View this table: View inline View popup Download powerpoint Table 4. BCGitis in KD and good response to intravenous immunoglobulins 3.8 Coronary artery abnormalities (CAA) by BCGitis status This was reported in four studies (n=17,920). Three studies reported separately coronary dilatation and aneurysm, with only one report merging both. Two reports showed lower rates of coronary dilatation in children with BCGitis (11.6% vs 13.8%; 20.0% vs 22.0%; 4.3% vs 7.1%), while one showed slightly higher prevalence without BCGitis (11.8% vs 7.7%). Aneurysms were absent in two reports, with only one study showing marginally lower rates without BCGitis (3.0 vs 4.3%) (Supplementary file: Table 3 A). In seven studies, the overall CAA prevalence was 12.3% for children vaccinated with the Tokyo strain and 11.8% for those with the Pasteur strain (Supplementary file: Table 3 B). 3.9 Synthesis of results From 15 studies from five Asian countries (Japan, Korea, Taiwan, China, Singapore), including 21,880 children with KD, the overall prevalence of BCGitis was 40.1%. Younger children consistently showed a higher prevalence. BCGitis was associated with lower CAA rates (11.8% vs 13.8%) but showed no significant association with KD type, vaccine strain, or treatment response 4. DISCUSSION 4.1 Summary of evidence This scoping review provides the first comprehensive synthesis of information about BCGitis in Kawasaki disease (KD). It was performed on data from 15 studies conducted in five Asian countries, encompassing > 20,000 children. Despite heterogeneity among these studies in their design, the overall prevalence of BCGitis was approximately 40%, supporting earlier findings. 15 , 16 This further reinforces its position as a reliable diagnostic marker instead of a coincidental discovery. The prevalence did not differ by BCG vaccine strain, suggesting that host response, rather than vaccine composition, is the primary determinant. There was a significant inverse association between BCGitis prevalence and age, with younger children being the most affected and having a higher risk of incomplete KD and cardiovascular problems. 7 , 8 , 16 , 17 This finding, correlating with a shorter interval since receiving the vaccine in early infancy, may likely reflect greater immunological activity at the BCG site in infancy. 8 , 18 – 20 Although a male predominance was noted, contrary to earlier investigations, this difference could not be explained. 8 , 11 In agreement with other research, the prevalence of BCGitis did not vary between full and incomplete KD. 8 , 21 This emphasises its potential utility as a diagnostic tool in both forms and reinforces its application as an auxiliary criterion to mitigate diagnostic delays. The review corroborates several prior studies where coronary artery anomalies were more prevalent in children without BCGitis. 5 , 7 , 8 , 20 It has been suggested that this is because BCGitis is recognised earlier than other signs in KD, leading to earlier treatment. Alternatively, it may also delineate a KD phenotype with increased cutaneous involvement and diminished coronary vasculitis. The lack of correlation between BCGitis and IVIG resistance reinforces the notion that it signifies a distinct immunophenotype rather than general disease severity. 4.2 Strengths This review focused exclusively on KD in BCG-vaccinated children, ensuring internal validity because unvaccinated children are incapable of developing BCGitis. All the reviewed studies systematically examined BCG vaccination sites. The substantial cumulative sample size (>20,000 patients) and geographic variety across various Asian nations augment the generalizability of these results among vaccinated populations. The age-related pattern of BCGitis occurrence and its correlation with reduced CAA rates were constant across various study designs and healthcare systems, hence reinforcing the conclusions. 4.3 Limitations There are a few limitations that need to be recognised. Most of the reviewed studies were retrospective, making them susceptible to selection and detection bias, especially if doctors were aware of the KD diagnosis before assessing BCG sites. Some case reports have indicated that BCGitis can appear by day 3 or 4 of KD, occasionally preceding other signs. 22 The studies included in this review, however, did not report on this specific timing relative to other signs of KD. 18 , 19 , 22 This, therefore, hinders the evaluation of its efficacy as an early diagnostic indicator in KD. In addition, individual patient-level data were unavailable, thus preventing multivariate analysis to adjust for confounders such as treatment timing, sex, or vaccination age. Standardised definitions of BCGitis and CAA were sometimes lacking, with several investigations amalgamating coronary dilation and aneurysms. All included studies were conducted in Asian countries with universal BCG vaccination. The findings, therefore, limit their relevance to other contexts. Differences in timing, strain, and administration technique were rarely detailed, though they may influence BCGitis occurrence. While publication bias may exist, the inclusion of research with relatively low prevalence indicates that negative findings were also documented. Lastly, diagnostic accuracy metrics such as sensitivity and specificity could not be calculated due to the lack of an appropriate control group (BCGitis in non-BCG-vaccinated children). Other constraints must also be acknowledged when interpreting these findings. The decision to include prevalence calculations is not common in scoping reviews, though this approach was justified because the primary outcome was homogeneous and summary estimates were clinically important. In line with scoping review methodology, we did not evaluate the quality of the included studies; hence, we may not have identified all pertinent methodological considerations. 4.4 Recommendations for research Future studies should establish standardised definitions and assessment protocols for BCGitis. They should include a consensus on optimal examination timing and documentation methods. Prospective studies collecting individual-level data are needed to evaluate their diagnostic and prognostic value while controlling for confounding variables. Longitudinal studies could clarify onset, evolution, and resolution patterns of BCGitis. Multicenter studies in diverse geographic and ethnic populations are essential to ascertain generalizability. The notably lower prevalence reported in the two studies from China warrants further investigation into strain-related or population or methodological factors. 23 , 24 Clinical trials should determine if systematic evaluation of BCGitis improves diagnostic accuracy, reduces treatment delays, and lowers CAA risk. Due to its ease and lack of expense, routine evaluation of BCG sites may be a useful addition to KD diagnostic algorithms, particularly in populations that have received the BCG vaccine. 4.5 Conclusions Conclusive recommendations await well-designed prospective studies. However, existing evidence suggests an important role for BCGitis as a useful supportive evidence for KD, especially in younger children and incomplete KD cases. Healthcare practitioners in BCG-vaccinated populations should routinely evaluate BCG vaccination sites in febrile children suspected of KD without incurring additional costs or resources. However, increasing population mobility leads to the inclusion in these countries of a pool of children vaccinated with BCG in their original country. Therefore, systematic assessment of BCGitis remains relevant and may aid earlier KD diagnosis even in countries without universal BCG vaccination. Data Availability All data produced in the present work are contained in the manuscript FUNDING None COMPETING INTERESTS None declared. ETHICAL APPROVAL None required DATA SHARING All the data supporting the findings of this study are available from the cited references. AUTHOR STATEMENTS HN conceptualised and designed the review, had primary responsibility for protocol development, literature search, screening of titles and abstracts, retrieving and reading the eligible studies, extracting and analysing the data, writing the first draft of the manuscript and approving the final version. AS participated in the screening of titles and abstracts, reading the eligible studies, extraction of the data, contributed to the writing of the manuscript and approved the final version Footnotes Email: hassib.narchi{at}uaeu.ac.ae , alysonskinner8{at}gmail.com REFERENCES 1. ↵ Loh ACE , Kua PHJ , Tan ZL . Erythema and induration of the Bacillus Calmette- Guerin site for diagnosing Kawasaki disease . Singapore Med J . 2019 ; 60 ( 2 ): 89 – 93 . OpenUrl CrossRef PubMed 2. ↵ Sahu S , Behera J , Rup A , et al. Clinical manifestations and outcomes of Kawasaki Disease: A retrospective hospital-based data from Eastern India . Indian Journal of Rheumatology . 2021 ; 16 ( 4 ). 3. ↵ Diagnostic guidelines for Kawasaki disease . American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease . Am J Dis Child . 1990 ;144(11):1218–1219. 4. ↵ McCrindle BW , Rowley AH , Newburger JW , et al. Diagnosis, Treatment, and Long- Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association . Circulation . 2017 ; 135 ( 17 ): e927 – e999 . OpenUrl Abstract / FREE Full Text 5. ↵ Park SH , Yu JJ , You J , et al. Clinical significance of the bacille calmette-guérin site reaction in kawasaki disease patients aged less than 18 months . Pediatric Infection and Vaccine . 2018 ; 25 ( 3 ): 148 – 155 . OpenUrl 6. ↵ Seo JH , Yu JJ , Ko HK , Choi HS , Kim YH , Ko JK . Diagnosis of incomplete kawasaki disease in infants based on an inflammation at the bacille calmette-guerin inoculation site . Korean Circ J . 2012 ; 42 ( 12 ): 823 – 829 . OpenUrl CrossRef PubMed 7. ↵ Castillo-Moguel J , Ynga-Duran M , Galvez-Cuitiva E , Carrasco C , Sorcia-Ramirez G , Garrido-Garcia L . BCGits as a Clinical Diagnosis Marker in Mexican Children with Kawasaki Disease (Abstract0.35) . Circulation . 2015 ; 131 . 8. ↵ Garrido-Garcia LM , Castillo-Moguel A , Vazquez-Rivera M , Cravioto P , Fernando G . Reaction of the BCG Scar in the Acute Phase of Kawasaki Disease in Mexican Children . Pediatr Infect Dis J . 2017 ; 36 ( 10 ): e237 – e241 . OpenUrl CrossRef PubMed 9. Lai CC , Lee PC , Wang CC , Hwang BT , Meng CC , Tsai MC . Reaction at the bacillus Calmette--Guerin inoculation site in patients with Kawasaki disease . Pediatr Neonatol . 2013 ; 54 ( 1 ): 43 – 48 . OpenUrl CrossRef PubMed 10. Roh DE , Kwon JE , Kim YH . Bacille Calmette-Guerin Site Reactivation of Kawasaki Disease in Infants under 3 Months of Age: Relation with Diagnosis and Prognosis . Children (Basel ). 2022 ; 9 ( 6 ). 11. ↵ Lin MT , Wang JK , Yeh JI , et al. Clinical Implication of the C Allele of the ITPKC Gene SNP rs28493229 in Kawasaki Disease: Association With Disease Susceptibility and BCG Scar Reactivation . Pediatr Infect Dis J . 2011 ; 30 ( 2 ): 148 – 152 . OpenUrl CrossRef PubMed 12. ↵ Ayusawa M , Sonobe T , Uemura S , et al. Revision of diagnostic guidelines for Kawasaki disease (the 5th revised edition) . Pediatr Int . 2005 ; 47 ( 2 ): 232 – 234 . OpenUrl CrossRef PubMed Web of Science 13. ↵ Kobayashi T , Ayusawa M , Suzuki H , et al. Revision of diagnostic guidelines for Kawasaki disease (6th revised edition) . Pediatr Int . 2020 ; 62 ( 10 ): 1135 – 1138 . OpenUrl CrossRef PubMed 14. ↵ Tricco AC , Lillie E , Zarin W , et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation . Ann Intern Med . 2018 ; 169 ( 7 ): 467 – 473 . OpenUrl CrossRef PubMed 15. ↵ Rezai MS , Shahmohammadi S . Erythema at BCG Inoculation Site in Kawasaki Disease Patients . Mater Sociomed . 2014 ; 26 ( 4 ): 256 – 260 . OpenUrl PubMed 16. ↵ Uehara R , Igarashi H , Yashiro M , Nakamura Y , Yanagawa H . Kawasaki disease patients with redness or crust formation at the Bacille Calmette-Guerin inoculation site . Pediatr Infect Dis J . 2010 ; 29 ( 5 ): 430 – 433 . OpenUrl CrossRef PubMed Web of Science 17. ↵ Al Zubaidi A , Ghatasheh G , Karuppaswamy V , Narchi H . Epidemiology of Kawasaki Disease, Its Incomplete Form and Outcomes: A Single-Institution Experience in the United Arab Emirates . Cureus . 2023 ; 15 ( 12 ): e51320 . OpenUrl 18. ↵ Diniz LMO , Castanheira RG , Giampietro YG , et al. Diagnostic Value of the Reaction at the Bacillus Calmette-Guerin Vaccination Site in Kawasaki Disease . Rev Paul Pediatr . 2021 ; 39 : e2019338 . OpenUrl 19. ↵ Novais C , Fortunato F , Bicho A , Preto L . Bacillus Calmette-Guerin reactivation as a sign of incomplete Kawasaki disease . BMJ Case Rep . 2016 ; 2016 . 20. ↵ Yang MC , Wu KL , Huang CN , et al. Kawasaki disease in children with Bacillus Calmette-Guérin scar reactivity: Focus on coronary outcomes . Journal of the Formosan Medical Association . 2023 ; 122 ( 10 ): 1001 – 1007 . OpenUrl PubMed 21. ↵ Sittiwangkul R , Pongprot Y , Silvilairat S , Makonkaewkeyoon K . Clinical spectrum of incomplete Kawasaki disease in Thailand . Paediatr Int Child Health . 2013 ; 33 ( 3 ): 176 – 180 . OpenUrl CrossRef PubMed 22. ↵ Lim KYY , Chua MC , Tan NWH , Chandran S . Reactivation of BCG inoculation site in a child with febrile exanthema of 3 days duration: an early indicator of incomplete Kawasaki disease . BMJ Case Rep . 2020 ; 13 ( 12 ). 23. ↵ Peng Y , Liu X , Duan Z , Cai S , Duan J , Zhou Y . Age-related differences in clinical characteristics of kawasaki disease . Brazilian Journal of Medical and Biological Research . 2021 ; 54 ( 3 ): 1 – 6 . OpenUrl CrossRef 24. ↵ Ruan Y , Ye B , Zhao X . Clinical characteristics of kawasaki syndrome and the risk factors for coronary artery lesions in China . Pediatric Infectious Disease Journal . 2013 ; 32 ( 10 ): e397 – e402 . OpenUrl CrossRef PubMed 25. Yokota S , Tsubaki K , Kuriyama T , et al. Presence in Kawasaki disease of antibodies to mycobacterial heat-shock protein HSP65 and autoantibodies to epitopes of human HSP65 cognate antigen . Clin Immunol Immunopathol . 1993 ; 67 ( 2 ): 163 – 170 . OpenUrl CrossRef PubMed Web of Science 26. Teng MC , Wang LC , Yu HH , Lee JH , Yang YH , Chiang BL . Kawasaki disease and Henoch-Schönlein purpura - 10 years’ experience of childhood vasculitis at a university hospital in Taiwan . Journal of Microbiology, Immunology and Infection . 2012 ; 45 ( 1 ): 22 – 30 . OpenUrl 27. Kang J , Lee D , Seo I , et al. Early Detection of Kawasaki Disease in Infants (Abstract 85) . Circulation . 2015 ; 131 . 28. Bae HK , Lee DK , Kwon JH , Kim HS , Sohn S , Hong YM . Clinical characteristics and serum N-terminal pro-brain natriuretic peptide as a diagnostic marker of Kawasaki disease in infants younger than 3 months of age . Korean Journal of Pediatrics . 2014 ; 57 ( 8 ): 357 – 362 . OpenUrl PubMed 29. Araki T , Kodera A , Kitada K , et al. Analysis of factors associated with development of Bacille Calmette-Guerin inoculation site change in patients with Kawasaki disease . J Int Med Res . 2018 ; 46 ( 4 ): 1640 – 1648 . OpenUrl CrossRef PubMed 30. Kim KY , Bae YS , Ji W , Shin D , Kim HS , Kim DS . ITPKC and SLC11A1 gene polymorphisms and gene-gene interactions in Korean patients with Kawasaki disease . Yonsei Medical Journal . 2018 ; 59 ( 1 ): 119 – 127 . OpenUrl CrossRef PubMed 31. Takikawa H , Ae R , Matsubara Y , et al. Bacille Calmette-Guerin inoculation site changes and cardiac complications in patients with Kawasaki disease . Arch Dis Child . 2021 ; 106 ( 7 ): 669 – 673 . OpenUrl Abstract / FREE Full Text View the discussion thread. Back to top Previous Next Posted October 05, 2025. Download PDF Supplementary Material Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. 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