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Kawasaki disease: not exclusive to children


Kawasaki disease (KD) is a multisystem disease that mainly affects the blood vessels causing inflammation of different arteries.


The clinical presentation of the disease corresponds to a set of symptoms and signs that include fever (for more than 5 days), red eyes, lesions in the throat and mouth and some patients may have fissures on the lips and tongue, swollen hands and feet, and swollen glands. If not treated appropriately and in time, it can evolve and cause serious complications such as cardiovascular diseases (coronary artery aneurysm, thrombosis, stenosis) and even sudden death.


In general, it is more frequent in children under 5 years of age, and although its distribution is greater in countries such as Japan, Taiwan, and South Korea, in the United States of America, the incidence of hospitalizations for KD is 19/100,000 in children under 5 years of age.




Even though the cause is not yet known, it is believed that an unspecified agent produces an immune dysfunction in genetically predisposed subjects. Since this disease is mediated by the immune system, involving superantigens and increased circulating cytokines.


How is it diagnosed?


There is no established complementary laboratory or imaging test that is characteristic of KD. However, during the acute phase, hematology findings such as increased white blood cells (leukocytosis) and accelerated ESR (erythrocyte sedimentation rate) may be observed. In a urine examination, sterile pyuria with mild proteinuria and microhematuria may be found. While the echocardiogram may show alterations at 3-4 weeks of evolution.


The medical diagnosis is based on clinical criteria including febrile syndrome, red eyes (bilateral conjunctival injection), swollen cervical glands, exanthema, alterations in lips or oral mucosa, and alterations in extremities.


IN ADULTS...


Although Kawasaki disease is way more common in children, more and more cases of this disease are reported in adult patients.


The mechanism by which it occurs is not well understood, however, it has been linked to viral infections that trigger an immune reaction and ultimately produce the clinical picture of Kawasaki disease.


For example, a 37-year-old patient presented with symptoms of Kawasaki disease, and his laboratory studies revealed infection with coxsackievirus A4, so the researchers established a relationship between these two entities.


Another infection that has been linked to Kawasaki disease in adults is COVID-19. Kawasaki disease is believed to be the result of the infection or an abnormal response to the infection.


Research indicates that KD should also be considered in the differential diagnosis when adult patients present with a fever of unknown cause associated with a rash.


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Sources:


Agarwal, S. Kawasaki Disease: Etiopathogenesis and Novel Treatment Strategies. Expert Review of Clinical Immunology. 2016. Available at: [http://dx.doi.org/10.1080/1744666X.2017.1232165]



Adult-onset Kawasaki disease (mucocutaneous lymph node syndrome) and concurrent Coxsackievirus A4 infection: a case report. Available at: [https://www.dovepress.com/adult-onset-kawasaki-disease-mucocutaneous-lymph-node-syndrome-and-con-peer-reviewed-fulltext-article-IMCRJ]


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