Abstract
Despite more than four decades of investigation, the etiology of Kawasaki disease remains obscure, and none of the proposed etiologic theories for the disease have achieved independent confirmation. Clinical and epidemiologic features support an infectious cause, but the etiology remains unclear. The authors present a case of Kawasaki disease associated with Epstein-Barr virus and Mycoplasma pneumoniae infection in a 3.5-y-old boy. He received two doses of intravenous immunoglobulin due to prolonged course of Kawasaki disease but later had complicated autoimmune haemolytic anaemia. His prolonged fever subsided after azithromycin administration. Epstein-Barr virus infection was confirmed by molecular microbiological pathology of cervical lymph node and serological tests. The serological tests for Mycoplasma pneumoniae also revealed a positive result. Thus, it is concluded that Mycoplasma pneumoniae and Epstein-Barr virus infections may occur simultaneously in a child with Kawasaki disease. In addition, autoimmune hemolytic anaemia may be noted in Kawasaki disease patients after high-dose IVIG administration. To the authors’ knowledge, this is the first report of Kawasaki disease with Epstein-Barr virus and Mycoplasma pneumoniae in the English-language literature.
References
Rowley AH, Shulman ST. Pathogenesis and management of Kawasaki disease. Expert Rev Anti Infect Ther. 2010;8:197–203.
Wang JN, Wang SM, Liu CC, et al. Mycoplasma pneumoniae infection associated with Kawasaki disease. Acta Paediatr. 2001;90:594–5.
Iwanaga M, Takada K, Osato T, et al. Kawasaki disease and Epstein- Barr virus. Lancet. 1981;1:938–9.
Okano M, Hase N, Sakiyama Y, et al. Long-term observation in patients with Kawasaki syndrome and their relation to Epstein-Barr Virus infection. Pediatr Infect Dis J. 1990;9:139–41.
Meissner HC, Leung DYM. Superantigens, conventional antigens and the etiology of Kawasaki disease. Pediatr Infect Dis J. 2000;19:91–4.
Leen C, Ling S. Mycoplasma infection and Kawasaki disease. Arch Dis Child. 1996;75:266–7.
Narita M, Yamada S, Nakayama T, et al. Two cases of lymphadenopathy with liver dysfunction due to Mycoplasma Pneumoniae infection with mycoplasma bacteraemia without pneumonia. J Infect. 2001;42:154–6.
Nakagawa M, Watanabe N, Okuno M, et al. Severe hemolytic anemia following high dose intravenous immunoglobulin administration in a patient with Kawasaki disease. Am J Hematol. 2000;63:159–62.
Wang JL, Ho MY, Shen EY. Mycoplasma Pneumoniae infection associated with hemolytic anemia: report of one case. Acta Paediatr Taiwan. 2004;45:293–5.
Khan FY, Yassin MA. Mycoplasma pneumoniae associated with severe autoimmune hemolytic anemia: case report and literature review. Brazilian. J Infect Dis. 2009;13:77–9.
Conflict of Interest
None.
Role of Funding Source
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Huang, FL., Chang, TK., Jan, SL. et al. Co-morbidity of Kawasaki Disease. Indian J Pediatr 79, 815–817 (2012). https://doi.org/10.1007/s12098-011-0589-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12098-011-0589-4