Advances in Kawasaki disease

Abstract

The mainstays of therapy for Kawasaki disease (KD)—IvIG and salicylates—have been employed for years and have proven efficacy. Current advances in KD have mainly been in the areas of understanding pathophysiology and improving diagnosis. The recent recognition of “incomplete KD” is a prime example of the latter. Articles in this issue of The Journal advance our understanding of KD on both fronts. A report from Wu et al in Taiwan reminds us that the vascular inflammation of KD is not limited to the coronary arteries. About 40% of children in this study had evidence of renal inflammation by PET scanning. Of these, there was evidence of increased urinary cytokine excretion and ultrasound evidence of vasculitis in comparison to the children whose PET scans did not show renal inflammation. Although renal problems in KD are generally considered to be self-limited, it will be of great interest to follow such children into adulthood, looking for problems such as hypertension. Another study, from Nomura et al in Japan, looked at the subset of children with KD whose presentation was atypical in being limited to fever and cervical adenopathy. These children tended to be older and had a higher risk of nonresponse to IvIG or the development of coronary artery aneurysms. Although the vast majority of children with fever and cervical adenopathy have bacterial or viral adenitis, we must remember to keep KD in the differential diagnosis. A Severe Form of Kawasaki Disease Presenting with Only Fever and Cervical Lymphadenopathy at AdmissionThe Journal of PediatricsVol. 156Issue 5PreviewTo examine the characteristics of patients with Kawasaki disease (KD) presenting with only fever and cervical lymphadenopathy at admission. Full-Text PDF Urinary Cytokines and Renal Doppler Study in Kawasaki DiseaseThe Journal of PediatricsVol. 156Issue 5PreviewTo investigate whether renal vasculitis is the sole cause or merely a contributing cause of renal inflammation in Kawasaki disease (KD). Full-Text PDF