Adult Kawasaki disease: report of two cases and literature review.
OBJECTIVE
To describe 2 cases of adult Kawasaki Disease (KD) and to review the medical literature to better define the epidemiological, clinical, laboratory, histopathological, cardiovascular, and therapeutic aspects of adult KD compared with pediatric KD.


METHODS
Report of 2 cases, and review of the literature using a Medline search from 1967 to June 2003.


RESULTS
Including our 2 cases, there are 57 reports of adult KD, 74% among patients aged 18 to 30 years. Nine cases of KD associated with human immunodeficiency virus (HIV) infection were described, suggesting that an immunocompromised state may predispose to this syndrome. The incidence of specific diagnostic criteria was roughly similar in adults and in children. However, cheilitis, meningitis, and thrombocytosis were observed in a larger percentage of children, while arthralgia, adenopathy, and liver function abnormality were more common in adults. Although adult KD often was diagnosed after the acute phase, when a significant beneficial effect from gammaglobulin infusion could not be expected, this treatment did appear to shorten the course of the disease. Coronary aneurysms were less frequent in adults than in children. Prognosis was more favorable in adults, with less cardiovascular complications and no deaths.


CONCLUSIONS
Adult KD is a rare condition, which may go unrecognized. Other known disease processes with similar clinical presentations such as hypersensitivity drug reaction and toxic shock syndrome must be ruled out. For adult KD, exclusion criteria such as absence of hypotension, visceral impairment, staphylococcal infection, and any drug able to induce a drug hypersensitivity reaction are suggestive of the diagnosis, in the presence of the inclusion criteria, rash, conjunctival effusion, oropharynx changes, extremity changes, or adenopathy.
Sève
Pascal
P
Hospices Civils de Lyon, Université Claude Bernard Lyon 1, France.
Stankovic
Katia
K
Smail
Amar
A
Durand
Denis Vital
DV
Marchand
Guillaume
G
Broussolle
Christiane
C
D000328:Adult; D017668:Age of Onset; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D003323:Coronary Aneurysm / Q000209:etiology / Q000473:pathology; D003937:Diagnosis, Differential; D004342:Drug Hypersensitivity / Q000175:diagnosis; D005260:Female; D006801:Humans; D016239:MEDLINE; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D012772:Shock, Septic / Q000175:diagnosis
D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin