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Kawasaki disease occurs in adults too. Interactive case report. A two year old child with rash and fever.
- Kathir G Yoganathan (23 October 2003)
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How soon should you think of Kawasaki's Disease?
- Janaki Menon (31 December 2003)
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Kathir G Yoganathan, Consultant HIV Physician GUM, Singleton Hospital, Sketty,Swansea SA2 8QA
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The Editor BMJ Kawasaki disease occurs in adults too. Interactive case report. A two-year-old child with rash and fever Dear Editor, I read your interactive case report concerning a two-year-old child with rash and fever with great interest1. However, I would like to point out that although Kawasaki disease (KD) is traditionally considered a disease of childhood, the rising number of reports in older age groups also make it an important differential diagnosis in adults with unexplained fever and rash. As the authors highlighted, early diagnosis, which is made entirely on clinical features, is crucial to prevent potentially fatal complications of coronary artery aneurysms. The typical age range of KD is six months to five years but it is important not to miss teenage and adult disease. Clinicians should be alerted to adult KD, which has been increasingly reported since 1977 when Kawasaki described the first adult case. 2. In 1997 Butler and colleagues described 11 cases of adult KD with an age range of 18 -40years3. Similarly we reported a case of Kawasaki like disease in an HIV positive adult who had all the six principle features of KD – fever of unknown aetiology lasting five days or more, bilateral congestion of the conjunctiva, diffuse erythema of buccal and pharyngeal mucosa, localised lymph node enlargement, polymorphous exanthem and changes of his extremities with peeling. Most importantly no other cause could be found for his illness4. Staphylococcal toxin associated syndrome in HIV positive adults, which closely resembles KD, has also been reported 5. No specific laboratory investigation or characteristic histopathological finding is available for the diagnosis of KD and it can be easily mistaken for other viral illnesses. Thus irrespective of age a possible diagnosis of KD should be considered whenever clinical findings are suggestive. 1. Sharma R, Boon A, Harnden A. Interactive case report A two year old child with rash and fever BMJ 2003; 327:668 2. Kawasaki T. Adult type MCLS. Med Technol 1997; 5:845. 3. Butler DF,Hough DR,Friedman SJ, Davis HE. Adult Kawasaki syndrome Arch Dermatol 1987; 123:1356-61 4. Yoganathan K, Goodman F, Pozniak A. Kawasaki like syndrome in an HIV positive adult. J Infect Dis 1995; 30:165-66 5.Stevens DL, Tanner MH, Winship J, et al. Severe group A streptococcal infections associated with a toxic shock – like syndrome and scarlet fever toxin. N Engl J Med 1989; 321: 1-7. Competing interests: None declared |
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Janaki Menon, Senior Lecturer in Pediatrics Medical College, Trissur, Kerala, India, 680004
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I came upon this case report in the December issue of BMJ, South asia Edition this evening. By strange coincidence, I presently have a very similar patient in my ward, whom I have started on Aspirin (100mg/kg)today. She is a 2yr old, who came to us with fever for 5 days associated with a pustule on her elbow and generalized erythema with strawberry tongue. There was no significant lymphadenopathy or conjunctival congestion. Her spleen was just palpable. We started her on Penicillin and Cloxacillin. But though her rash has given way to peeling on the extremities, she continues to spike. It is now 15 days into her fever. She too has neutrophilia, no thrombocytosis, high CRP, Sterile blood culture, negative ASLO, negative Widal, negative ANA, USG and Xrays show no occult foci of sepsis. Her ECHO is due tomorrow. We have put her on Aspirin nevertheless. Is there anything else you would suggest? Competing interests: None declared |
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