Abstract 31: Acute Febrile Acrodynia (1781-1966): Historical Cases Of Kawasaki Disease Before Kawasaki?

Abstract

Infantile acrodynia is a mercurial reaction that can mimic the complete clinical picture of Kawasaki disease (KD), and is therefore considered a differential diagnosis for KD. Before the 1950s, acrodynia affected 1 in 500 children in industrialized nations. The recently formed pediatric community was fascinated by this new disease since the late 1800s, resulting from the child’s extreme irritability along with striking mucocutaneous changes such as the bright red, swollen hands and feet. Parents would initially report their child suffered from a sudden fever caused by an undetermined infection. Children were not typically seen in hospital until their case became protracted and the insidious symptoms of advanced acrodynia were apparent weeks later. In the 1950s, it was discovered that mercurial remedies such as teething powders were a cause of acrodynia, leading to their removal from the market. Physicians in the British Isles first reported acrodynia in the medical literature after the use of mercurials were extended from adult syphilitic patients to the generalized patient population in the late 1700s. Previously, these acute febrile mercurial reactions were mistaken as a form of secondary syphilis. During the early to mid-1900s, it was noted that syphilitic patients undergoing mercurial or arsenical treatment were more likely to develop arterial thromboses, particularly of the coronary arteries, leading to diagnoses of a unique polyarteritis nodosa. Sudden death in infantile acrodynia often results from secondary infections, arterial thromboses, and cardiac failure. Shortly after acrodynia became a rare pediatric ailment, KD was first observed by Kawasaki in 1961 and reported in 1967. This coincides with unprecedented increases of mercury pollution and seafood contamination in East Asia, resulting in Minamata disease outbreaks during the 1950s and 1960s in Japan. Outbreaks of Minamata disease have been observed among indigenous populations in Canada since the 1970s, while Canada has the highest rates of KD outside of East Asia or Hawaii. Temporal associations are seen with increases and reductions of thimerosal from routine pediatric vaccines and KD outbreaks in the US and Japan. KD may in part represent a modern re-emergence of infantile acrodynia.