Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Medical Case Reports
Published in: Journal of Medical Case Reports 1/2015

Open Access 01-12-2015 | Case report

Adult Kawasaki disease in a European patient: a case report and review of the literature

Authors: Theano Kontopoulou, Dimitrios Georgios Kontopoulos, Emmanouel Vaidakis, George P Mousoulis

Published in: Journal of Medical Case Reports | Issue 1/2015

Login to get access

Abstract

Introduction

Kawasaki disease is an acute necrotising vasculitis of the medium- and small-sized vessels, occurring mainly in Japanese and Korean babies and children, aged 6 months to 5 years. Its main complication is damage of coronary arteries, which has the potential to be fatal. Here we report a rare case of Kawasaki disease that occurred in a 20-year-old Greek adult.

Case presentation

A 20-year-old Greek man presented with high fever, appetite loss, nausea and vomiting, headache and significant malaise. He had an erythema of the palms and strikingly red lips and conjunctiva. As he did not respond to broad-spectrum antibiotics and after having excluded other possible diagnoses, the diagnosis of Kawasaki disease was set. He was treated with intravenous immunoglobulin and oral aspirin on the 10th day since the onset of the illness. His clinico-laboratory response was excellent and no coronary artery aneurysms were detected in coronary artery computed tomography performed 1 month later.

Conclusions

This report of an adult case of European Kawasaki disease may be of benefit to physicians of various specialties, including primary care doctors, hospital internists, intensivists and cardiologists. It demonstrates that a case of prolonged fever, unresponsive to antibiotics, in the absence of other diagnoses may be an incident of Kawasaki disease. It is worth stressing that such a diagnosis should be considered, even if the patient is adult and not of Asian lineage.
Literature
1.
Cai Z, Zuo R, Liu Y. Characteristics of Kawasaki disease in older children. Clin Pediatr (Phila). 2011;50(10):952–6.
2.
Wolf AE, Hansen KE, Zakowski L. Acute Kawasaki disease: not just for kids. J Gen Intern Med. 2007;22(5):681–4.
3.
Senzaki H. Long-term outcome of Kawasaki disease. Circulation. 2008;118(25):2763–72.PubMed
4.
Uehara R, Belay ED. Epidemiology of Kawasaki disease in Asia, Europe, and the United States. J Epidemiol. 2012;22(2):79–85.PubMedPubMedCentral
5.
Sève P, Lega JC. Maladie de Kawasaki de l’adulte. Rev Med Interne. 2011;32(1):17–25.PubMed
6.
Campos-Franco J, Lopez R, Alende R, Gonzalez-Quintela A. Adult Kawasaki disease. Intern Med. 2011;50(13):1443–4.PubMed
7.
Ataya A, Alraiyes AH, Auron M, Alraies MC. Adult Kawasaki disease. QJM. 2013;106:687–8.PubMed
8.
Kanno K, Sakai H, Nakajima M, Satake A, Konishi T, Iizuka H. An adult case of Kawasaki disease in a pregnant Japanese woman: a case report. Case Rep Dermatol. 2011;3(1):98–102.PubMedPubMedCentral
9.
Kim JS, Chun KJ, Park YH, Kim JH, Kim J. Characteristic findings of coronary artery disease in Kawasaki disease. J Am Coll Cardiol. 2011;57(7):884.PubMed
10.
Inokuchi R, Kurata H, Harada M, Aoki Y, Matsubara T, Doi K, et al. Coronary artery aneurysms after adult-onset Kawasaki disease. Circulation. 2013;127(15):1636. 7.PubMed
11.
12.
Bresson V, Bonello B, Rousset-Rouvière C, Serratrice J, Chabrol B, Dubus JC, et al. Maladie de Kawasaki chez le grand enfant et l'adulte jeune: expérience marseillaise sur 10 ans. Arch Pediatr. 2011;18(7):731–6.PubMed
13.
Fujimoto N, Teramura K, Toshihiro T. Adult Kawasaki disease: evaluating the fluctuation of circulating lymphocytes associated with i.v. immunoglobulin treatment. J Dermatol. 2012;39(11):957–8.PubMed
14.
Rodó X, Ballester J, Cayan D, Melish ME, Nakamura Y, Uehara R, et al. Association of Kawasaki disease with tropospheric wind patterns. Sci Rep. 2011;1:152.PubMedPubMedCentral
15.
Hattori T, Matsukawa Y, Takei M, Yamaguchi K, Yamazaki T, Sawada U, et al. Adult Kawasaki disease unrelated to Epstein-Barr virus and group A Streptococcus. Intern Med. 2005;44(11):1182–4.PubMed
16.
Rodó X, Curcoll R, Robinson M, Ballester J, Burns JC, Cayan DR, et al. Tropospheric winds from northeastern China carry the etiologic agent of Kawasaki disease from its source to Japan. Proc Natl Acad Sci U S A. 2014;111(22):7952–7.PubMedPubMedCentral
17.
Li Z, Chao TC, Chang KY, Lin N, Patil VS, Shimizu C, et al. The long noncoding RNA THRIL regulates TNFα expression through its interaction with hnRNPL. Proc Natl Acad Sci U S A. 2014;111(3):1002–7.PubMed
18.
Lehman TJ, Warren R, Gietl D, Mahnovski V, Prescott M. Variable expression of Lactobacillus casei cell wall-induced coronary arteritis: an animal model of Kawasaki's disease in selected inbred mouse strains. Clin Immunol Immunopathol. 1988;48(1):108–18.PubMed
19.
Onouchi Y, Gunji T, Burns JC, Shimizu C, Newburger JW, Yashiro M, et al. ITPKC functional polymorphism associated with Kawasaki Disease susceptibility and formation of coronary artery aneurysms. Nat Genet. 2008;40(1):35–42.PubMed
20.
Onouchi Y, Ozaki K, Buns JC, Shimizu C, Hamada H, Honda T, et al. Common variants in CASP3 confer susceptibility to Kawasaki Disease. Hum Mol Genet. 2010;19(14):2898–906.PubMedPubMedCentral
21.
Khor CC, Davila S, Breunis WB, Lee YC, Shimizu C, Wright VJ, et al. Genome-wide association study identifies FCGR2A as a susceptibility locus for Kawasaki Disease. Nat Genet. 2011;43(12):1241–6.PubMed
22.
Onouchi Y, Ozaki K, Burns JC, Shimizu C, Terai M, Hamada H, et al. A genome-wide association study identifies three new risk loci for Kawasaki Disease. Nat Genet. 2012;44(5):517–21.PubMed
23.
Lee YC, Kuo HC, Chang JS, Chang LY, Huang LM, Chen MR, et al. Two new susceptibility loci for Kawasaki Disease identified through genome-wide association analysis. Nat Genet. 2012;44(5):522–5.PubMed
24.
Kentsis A, Shulman A, Ahmed S, Brennan E, Monuteaux MC, Lee YH, et al. Urine proteomics for discovery of improved diagnostic markers of Kawasaki Disease. EMBO Mol Med. 2013;5(2):210–20.PubMed
25.
Gziut AI, Gil RJ. Coronary aneurysms. Pol Arch Med Wewn. 2008;118(12):741–6.PubMed
26.
Falcini F, Capannini S, Rigante D. Kawasaki syndrome: an intriguing disease with numerous unsolved dilemmas. Pediatr Rheumatol Online J. 2011;9:17.PubMedPubMedCentral
27.
Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young. American Heart Association Circulation. 2004;110(17):2747–71.PubMed
28.
Weng KP, Hsieh KS, Hwang YT, Huang SH, Lai TJ, Yuh YS, et al. IL-10 polymorphisms are associated with coronary artery lesions in acute stage of Kawasaki disease. Circ J. 2010;74(5):983–9.PubMed
29.
Choi YM, Shim KS, Yoon KL, Han MY, Cha SH, Kim SK, et al. Transforming growth factor beta receptor II polymorphisms are associated with Kawasaki Disease. Korean J Pediatr. 2012;55(1):18–23.PubMedPubMedCentral
30.
Yu HR, Chang WP, Wang L, Lin YJ, Liang CD, Yang KD, et al. DC-SIGN (CD209) promoter −336 A/G (rs4804803) polymorphism associated with susceptibility of Kawasaki disease. ScientificWorldJournal. 2012;2012:634835.PubMedPubMedCentral
31.
Kim JJ, Park YM, Yoon D, Lee KY, Seob Song M, Doo Lee H, et al. Identification of KCNN2 as a susceptibility locus for coronary artery aneurysms in Kawasaki Disease using genome-wide association analysis. J Hum Genet. 2013;58(8):521–5.PubMed
32.
Caputo AE, Roberts WN, San Yee Y, Posner MP. Hepatic artery aneurysm in corticosteroid-treated adult Kawasaki’s Disease. Ann Vasc Surg. 1991;5(6):533–7.PubMed
33.
Bonté I, Mahr A, Laroche L, Guillevin L, Robineau M. Peripheral gangrene in adult-onset Kawasaki disease. Scand J Rheumatol. 2005;34(1):71–3.PubMed
34.
Huong DL, Gatfosse M, Papo T, Barjonet G, Lacombe P, Godeau P. Symptomatic splenic infarction complicating adult Kawasaki disease. Br J Rheumatol. 1995;34(6):579–80.PubMed
35.
Galempoix JM, Kaeppler E, Lanoux P, Belaïda A, Aboutara M, Penalba C. Maladie de Kawasaki de l’adulte: à propos d’un cas. Rev Med Interne. 2006;27(8):646–9.PubMed
36.
Machet L, Vaillant L, Goutal H, Lanternier G, Khallouf R, Chagnon JL, et al. Kawasaki disease in a young adult with a perineal rash. Br J Dermatol. 1990;123(3):413–4.PubMed
37.
Wolf II CV, Wolf JR, Parker JS. Kawasaki’s syndrome in a man with the human immunodeficiency virus. Am J Ophthalmol. 1995;120(1):117–8.PubMed
38.
Yoganathan K, Goodman F, Pozniak A. Kawasaki-like syndrome in an HIV positive adult. J Infect. 1995;30(2):165–6.PubMed
39.
Johnson RM, Little JR, Storch GA. Kawasaki-like syndromes associated with human immunodeficiency virus infection. Clin Infect Dis. 2001;32(11):1628–34.PubMed
40.
Stankovic K, Miailhes P, Bessis D, Ferry T, Broussolle C, Sève P. Kawasaki-like syndromes in HIV infected adults. J Infect. 2007;55(6):488–94.PubMed
41.
Michels TC. Mucocutaneous lymph node syndrome in adults – differentiation from toxic shock syndrome. Am J Med. 1986;80(4):724–8.PubMed
42.
Blanchard JN, Powell HC, Freeman WR, Letendre S, Blanchard D, Shimizu C, et al. Recurrent Kawasaki disease-like syndrome in a patient with acquired immunodeficiency syndrome. Clin Infect Dis. 2003;36(1):105–11.PubMed
43.
McIlroy MA, Fisher EJ, Saravolatz LD, Hardwicke MB, Wilson FM. Aseptic meningitis complicating adult Kawasaki disease: case report and review of the literature. Am J Med. 1989;87(1):106–10.PubMed
44.
Shelleh HH, Khan SA, Khan LA, Al-Hateeti H, Iqbal S, Saleh AF. Adult Kawasaki disease. Saudi Med J. 2000;21(11):1078–80.PubMed
45.
Fajon JT, Fry YW, Smith D. Kawasaki disease in a postpartum patient. J Natl Med Assoc. 2004;96(11):1499–502.
46.
Leclerc G, Bégin P, Laramée P, Genest P. Transient heart failure in an adult with Kawasaki disease. Clin Cardiol. 1986;9(3):128–30.PubMed
47.
Marcella JJ, Ursell PC, Goldberger M, Lovejoy W, Fenoglio JJ, Weiss MB. Kawasaki syndrome in an adult: endomyocardial histology and ventricular function during acute and recovery phases of illness. J Am Coll Cardiol. 1983;2(2):374–8.PubMed
48.
Gomberg R, Hamm P, Martin A. Mucocutaneous lymph node syndrome (Kawasaki Disease) in an adult. West J Med. 1981;135(5):406–8.PubMedPubMedCentral
49.
Granel B, Serratrice J, Ene N, Igual JP, Habib G, Disdier P, et al. Painful jaundice revealing Kawasaki disease in a young man. J Gastroenterol Hepatol. 2004;19(6):713–5.PubMed
50.
Muniain-Ezcurra M, Bueno-Mariscal C, Rodríguez-Baño J, Domínguez-Castellano A, Balonga-Tomás B, Ríos-Villegas MJ, et al. Kawasaki disease and parvovirus B19 infection in an adult HIV-1-infected patient. Clin Microbiol Infect. 1998;4(10):609–10.PubMed
51.
Sève P, Stankovic K, Smail A, Durand DV, Marchand G, Broussolle C. Adult Kawasaki disease: report of two cases and literature review. Semin Arthritis Rheum. 2005;34(6):785–92.PubMed
52.
Bachmeyer C, Turc Y, Curan D, Duval-Arnould M. Anterior uveitis as the initial sign of adult Kawasaki syndrome (mucocutaneous lymph node syndrome). Am J Ophthalmol. 2000;129(1):101–2.PubMed
53.
Pérez-Rodon J, Aboal J, Morales M, Masià R. Kawasaki disease with coronary involvement in adults. Rev Esp Cardiol (Engl Ed). 2006;59(11):1203–4.
54.
Takamoto T, Niwa A, Taniguchi K, Takeuchi J. Acute febrile mucocutaneous lymph node syndrome (Kawasaki Disease) in an adult. Clin Cardiol. 1982;5(10):555–9.PubMed
55.
Tomiyama J, Hasegawa Y, Kumagai Y, Adachi Y, Karasawa K. Acute febrile mucocutaneous lymph node syndrome (Kawasaki Disease) in adults: case report and review of the literature. Jpn J Med. 1991;30(3):285–9.PubMed
56.
Phillips WG, Marsden JR. Adult Kawasaki syndrome. Br J Dermatol. 1993;129(3):330–3.PubMed
57.
Thompson AC, Lamey PJ. Kawasaki syndrome in an adult. J Laryngol Otol. 1990;104(1):37–8.PubMed
58.
Barbaro G, Di Lorenzo G, Barbarini G. Kawasaki-like syndrome in an HIV-infected adult. Rheumatology (Oxford). 2003;42(11):1427–9.
59.
Chang C, Wood JC, Strickling WA, Walsh DS. Kawasaki disease in a US army soldier highlights surveillance. Int J Rheumatol. 2006;45(1):83–4.
60.
El Karoui K, Servais A, Fadel F, Jablonski M, Fakhouri F, Lesavre P, et al. Acute renal failure and febrile rash – infectious or not? Nephrol Dial Transplant. 2007;22(3):949–51.PubMed
61.
Alves NR, Magalhães CM, Almeida RF, Santos RC, Gandolfi L, Pratesi R. Prospective study of Kawasaki disease complications: review of 115 cases. Rev Assoc Med Bras. 2011;57(3):295–300.PubMed
62.
Athappan G, Gale S, Ponniah T. Corticosteroid therapy for primary treatment of Kawasaki disease – weight of evidence: a meta-analysis and systematic review of the literature. Cardiovasc J Afr. 2009;20(4):233–6.PubMedPubMedCentral
63.
Alexoudi I, Kanakis M, Kapsimali V, Vaiopoulos G. Kawasaki disease: current aspects on aetiopathogenesis and therapeutic management. Autoimmun Rev. 2011;10(9):544–7.PubMed
64.
65.
Gordon JB, Kahn AM, Burns JC. When children with Kawasaki disease grow up: myocardial and vascular complications in adulthood. J Am Coll Cardiol. 2009;54(21):1911–20.PubMedPubMedCentral
66.
Metadata
Title
Adult Kawasaki disease in a European patient: a case report and review of the literature
Authors
Theano Kontopoulou
Dimitrios Georgios Kontopoulos
Emmanouel Vaidakis
George P Mousoulis
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2015
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/s13256-015-0516-9

Other articles of this Issue 1/2015

Journal of Medical Case Reports 1/2015 Go to the issue

Case report

Intraosseous lipoma of the third lumbar spine: a case report

Case report

A rare case of a splenic hamartoma in a patient with a huge palpable abdominal mass: a case report

Case report

An epidemiological investigation to reconstruct a probable human immunodeficiency virus -1 transmission network: a case report

Case report

Acromegaly presenting with low insulin-like growth factor-1 levels and diabetes: a case report

Case report

Delayed recognition of pediatric calcaneal osteomyelitis: a case report

Case report

Kidney transplantation in infantile myofibromatosis and fibromuscular dysplasia: a case report