title: IgA plasma cell infiltration of proximal respiratory tract, pancreas, kidney, and coronary artery in acute Kawasaki disease.
abstract: The etiology and pathogenesis of Kawasaki disease (KD) remain unknown. As previously reported, in US patients with acute KD, IgA plasma cells (PCs) infiltrate the vascular wall. To determine whether IgA PCs are increased at mucosal sites in KD and to determine whether other nonvascular KD tissues are infiltrated by IgA PCs, the cells were immunolocalized and quantitated in tissue sections taken from 18 US and Japanese patients who died of acute KD and from 10 age-matched controls. IgA PCs were significantly increased in the trachea of patients who died of acute KD, compared with controls (P<.01), a finding that was similar to findings in children with fatal respiratory viral infection. IgA PCs also infiltrated coronary artery, pancreas, and kidney in all KD patients. These findings strongly support entry of the KD etiologic agent through the upper respiratory tract, resulting in an IgA immune response, with systemic spread to vascular tissue, pancreas, and kidney.
authors.affiliation: Ward 12-140, Pediatrics W-140, Northwestern University Medical School, Chicago, IL 60611-3008, USA. a-rowley@northwestern.edu
authors.forename: A H
authors.initials: AH
authors.lastname: Rowley
authors.forename: S T
authors.initials: ST
authors.lastname: Shulman
authors.forename: C A
authors.initials: CA
authors.lastname: Mask
authors.forename: L S
authors.initials: LS
authors.lastname: Finn
authors.forename: M
authors.initials: M
authors.lastname: Terai
authors.forename: S C
authors.initials: SC
authors.lastname: Baker
authors.forename: C A
authors.initials: CA
authors.lastname: Galliani
authors.forename: K
authors.initials: K
authors.lastname: Takahashi
authors.forename: S
authors.initials: S
authors.lastname: Naoe
authors.forename: M B
authors.initials: MB
authors.lastname: Kalelkar
authors.forename: S E
authors.initials: SE
authors.lastname: Crawford
mesh_terms: D000208:Acute Disease; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003331:Coronary Vessels / Q000276:immunology / Q000473:pathology; D005006:Ethnicity; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis*; D007223:Infant; D007564:Japan; D007668:Kidney / Q000276:immunology / Q000473:pathology; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000276:immunology* / Q000473:pathology*; D010179:Pancreas / Q000276:immunology / Q000473:pathology; D010950:Plasma Cells / Q000276:immunology / Q000473:pathology*; D012137:Respiratory System / Q000276:immunology / Q000473:pathology; D014481:United States
chemical_list: D007070:Immunoglobulin A