Abstract 42: Simultaneous development of Kawasaki Disease associated with adenovirus infection in identical twins

Abstract

Background: The cause of Kawasaki disease (KD) remains unknown. However, many studies have suggested that specific genetic factors and some infectious agents could be associated with the onset of KD. Human adenovirus (AdV) infection is one of the triggering events in KD. We experienced identical twins who sequentially developed KD in conjunction with AdV infection. Patients: The patients were 4-year-old identical twin boys. The elder brother developed a high fever and was diagnosed with AdV infection by an immunochromatographic kit for AdV (IC-kit). He was transferred to our institute after persistence of fever for 7 days. On admission, he already fulfilled all of the diagnostic criteria of KD. The laboratory data were as follows: WBC, 9700/μl; CRP, 2.42 mg/dl; IFN-γ, 99.8 pg/ml; and TNF-α, 10.9 pg/ml. He received intravenous immunoglobulin (IVIG) and aspirin, and responded well without coronary artery abnormalities. The younger brother, who was also IC-kit-positive, was hospitalized on the same day as his elder brother after persistence of fever for 3 days. The data on admission were as follows: WBC, 12,600/μl; CRP, 5.54 mg/dl; IFN-γ, 105.0 pg/ml; and TNF-α, 33.6 pg/ml. Although he developed all of the KD symptoms by the 4th day, his fever spontaneously subsided on the 6th day without IVIG or aspirin. He developed dilation of the coronary artery on the 10th day at the left circumflex artery bifurcation area. This disappeared after 3 months with antiplatelet therapy. AdV type 3 (AdV3) DNA was detected in both of the patients’ stool samples by PCR, and AdV3 was isolated from the younger brother’s stool sample. Moreover, serum neutralizing antibody to AdV3 was greatly elevated in both of the patients. Discussion: Identical twins who simultaneously develop KD are rare. Both of the twin brothers were infected with AdV3 immediately before they developed symptoms of KD. The combined condition of genetic susceptibility and an infection could be an essential trigger in development of KD.