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PRACTICE: R Sivakumar, S Pavulari, and S Ellis Fever of unknown origin: case outcome BMJ 2006; 333: 691 [Full text]

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Kawasaki Disease in adults

Niranjini Subramaniam, Kathir.G.Yoganathan,Consultant Physician in HIV Medicine   (6 October 2006)

Kawasaki Disease in adults 6 October 2006
Niranjini Subramaniam, SHO Medicine(Locum) Swansea NHS Trust,Singleton Hospital,Swansea,SA2 8QA, Kathir.G.Yoganathan,Consultant Physician in HIV Medicine Send response to journal: Re: Kawasaki Disease in adults	Kawasaki Disease in adults Interactive case report: Fever of unknown origin: case outcome Dear editor, We read your interactive case report regarding fever of unknown origin in a 19-year-old female student who presented with spiking temperature and macular erythematous rash. She had subsequently developed cervical lymphadenopathy1. However the authors failed to mention two important diferrential diagnosis which are adult Kawasaki syndrome and toxic shock syndrome. Kawasaki disease (KD) is an acute systemic vasculitis commonly seen in children under aged five. Kawasaki reported the first case of a man- aged 22years with Kawasaki syndrome in 1977 2.KD is a diagnosis of exclusion and has no single laboratory investigations or characteristic histopathological findings. Since then increasing number of cases has been reported worldwide 3 . Thus diagnosis is made entirely on clinical criteria: fever of unknown etiology lasting five days or more, localised lymphadenopathy,polymorphous erythematous rash with desquamation of extremities, bilateral conjunctival congestion, and diffuse buccal and pharyngeal erythema. This student did have four of five major criteria such as spiking temperatures of up to 40 0C, erythematous rash pronounced on the dorsal aspect of legs, localised cervical lymphadenopathy and sore throat. Above all, laboratory investigations did not reveal any causative agents. Furthermore she had other features of KD such as tender knee joint,pericardial effusion, leucocytosis with predominant neutrophilia and raised C reactive protein. She also developed acute renal failure which has been reported in KD4.She responded well with the steroids and IV immunoglobulin which is also in favour of KD. Toxic shock syndrome with multiple organ failure is another important diffential diagnosis in this case. However anti-staphylococcal antibody test was not mentioned. KD has a mortality rate of 3.7% in the UK5. Hence increased awareness of the disease in children and adults may facilitate earlier therapeutic interventions and shorten the hospital stay for investigating fever of unknown origin. Competing interests: None declared References: 1.Sivakumar R, Pavulari S, Ellis S. Fever of unknown origin:case outcome.BMJ 2006; 333:691-94. 2.Kawasaki T.Adult type MCLS.Med Technol 1997; 5:845. 3.Yoganathan K,Blackwell A. A teenager with rash and fever.Lancet 2002;359:1524. 4. Mac Ardle B M,Chambers T L,Weller S D V,Tribe C R.Acute renal failure in Kawasaki disease.J R Soc Med 1983;76:615-16. 5.Brogan P A,Bose A,Burgner D,et tal.Kawasaki disease: an evidence based approach to diagnosis,treatment,and proposals for future research. Arch Dis Child 2002; 86:286-90. Competing interests: None declared