Adult-onset Kawasaki disease (mucocutaneous lymph node syndrome) and concurrent Coxsackievirus A4 infection: a case report

Abstract

Introduction: Kawasaki disease (KD) most commonly develops in infants, although its specific cause is still unclear. We report here a rare case of adult-onset KD which revealed to be concurrently infected by Coxsackievirus A4.

Case presentation: The patient was a 37-year-old Japanese man who presented with fever, exanthema, changes in the peripheral extremities, bilateral non-exudative conjunctival injection, and changes in the oropharynx, signs that meet the diagnostic criteria for KD defined by the Centers for Disease Control and Prevention. In this case, the patient had a significantly high antibody titer for Coxsackievirus A4, which led us to presume that the occurrence of KD was concurrent Coxsackievirus A4 infection.

Conclusion: We reported a very rare case of KD which suggests that the disease can be concurrent Coxsackievirus A4 infection. Although KD is an acute childhood disease, with fever as one of the principal features, KD should also be considered in the differential diagnosis when adult patients present with a fever of unknown cause associated with a rash.

Keywords: Coxsackievirus A4; Kawasaki disease; adult-onset; mucocutaneous lymph node syndrome; skin rash.

Figure 1

Desquamation around the (A) lips, (B) fingers, and (C) feet, and (D) bilateral non-exudative conjunctival injection. Note: At the time of admission to our hospital, physical examination showed desquamation around the lips, fingers, and feet, and his conjunctivae were markedly congested.

Figure 2

Clinical course. Notes: On the day of admission to our hospital, he was treated with 30 mg/kg/day of oral aspirin. On day 4, the dose of aspirin was reduced to 5 mg/kg/day because of defervescence. After day 6 in our hospital, the myalgia, congested conjunctivae, erythema, and desquamations gradually resolved. By day 13, the erythema and desquamation were completely resolved. However, the treatment was switched from aspirin to 200 mg/day of cilostazol because of liver dysfunction as an adverse effect of aspirin. Abbreviations: WBC, White blood cell count; Plt, Platelet; ALT, Alanine aminotransferase.

Figure 3

Coronary computed tomography. Note: The coronary computed tomography that was performed 2 months after the onset of the disease revealed no coronary aneurysms. Abbreviations: LCX, left circumflex artery; LAD, left anterior descending coronary artery; RCA, right coronary artery.