Acute Kawasaki Disease in Association with Burn Injury

Abstract

While the etiology of Kawasaki disease (KD) is unknown, a role for infectious agents, including common skin organisms, has been proposed. We report 2 cases of KD associated with burn injury. Case 1: A 2 year old boy was admitted with a first and second degree scald injury to more than 9% of his body. Initial leukocyte count (WBC) was elevated. He was discharged to home the next day, and on daily visits was noted to have decreased fluid intake with fever without an infectious source. A generalized macular rash developed and he was readmitted with persistent fever. He subsequently developed conjunctivitis, oral changes and unilateral cervical lymphadenopathy with erythema of his palms. He had elevated WBC, ESR and liver transaminases. Acute KD was diagnosed and he received a single dose of IVIG on day 8 of his illness, with good response. All culture results were negative. Initial and follow-up echocardiograms were normal. Case 2: A 2 year old boy was transferred to hospital with second degree scald injury to 20% of his body. Within 24 hours he developed fever and cough, which continued without an infectious source for the next 6 days. He developed conjunctivitis and oral changes, with normal WBC, elevated ESR and normal liver transaminases. A diagnosis of atypical KD was considered, and he subsequently developed a generalized rash and extremity changes. A single dose of IVIG was given on day 8 of his illness, with good response. Initial echocardiogram showed mild dilation of the left main coronary artery, which resolved by his 6 week assessment. All culture results were negative. We speculate that the association of KD with burn injury in these patients may relate to stress or injury-induced immunologic changes, skin or tissue antigen release, or weakened barrier for entry of skin and other organisms