Adult Kawasaki disease in a European patient: a case report and review of the literature

Abstract

Introduction: Kawasaki disease is an acute necrotising vasculitis of the medium- and small-sized vessels, occurring mainly in Japanese and Korean babies and children, aged 6 months to 5 years. Its main complication is damage of coronary arteries, which has the potential to be fatal. Here we report a rare case of Kawasaki disease that occurred in a 20-year-old Greek adult.

Case presentation: A 20-year-old Greek man presented with high fever, appetite loss, nausea and vomiting, headache and significant malaise. He had an erythema of the palms and strikingly red lips and conjunctiva. As he did not respond to broad-spectrum antibiotics and after having excluded other possible diagnoses, the diagnosis of Kawasaki disease was set. He was treated with intravenous immunoglobulin and oral aspirin on the 10th day since the onset of the illness. His clinico-laboratory response was excellent and no coronary artery aneurysms were detected in coronary artery computed tomography performed 1 month later.

Conclusions: This report of an adult case of European Kawasaki disease may be of benefit to physicians of various specialties, including primary care doctors, hospital internists, intensivists and cardiologists. It demonstrates that a case of prolonged fever, unresponsive to antibiotics, in the absence of other diagnoses may be an incident of Kawasaki disease. It is worth stressing that such a diagnosis should be considered, even if the patient is adult and not of Asian lineage.

Figure 1

A global map of reported adult Kawasaki disease cases, including the present one. The size of the circles is proportional to the number of published cases in each country, ranging from 1 to 36.

Figure 2

Evolution of clinico-laboratory data before and after intravenous immunoglobulin administration (A-F). Open circles correspond to the measured values of the patient. The general time trend for each variable is depicted via fitted Loess curves (in blue), with grey areas showing the 95% confidence interval. The black vertical line indicates the intravenous immunoglobulin treatment event. CRP, C-reactive protein; FCT, Fibrinogen clotting time; PLT, Platelets; WBC, White blood cell count.