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http://dx.doi.org/10.3345/kjp.2009.52.9.1029

A case of adolescent Kawasaki disease with Epstein-Barr virus-associated infectious mononucleosis complicated by splenic infarction  

Choi, Byeong Sam (Departments of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine)
Kwon, Bo Sang (Departments of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine)
Kim, Gi Beom (Departments of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine)
Jeon, Yoon Kyung (Departments of Pathology, Seoul National University Children's Hospital, Seoul National University College of Medicine)
Cheon, Jung-Eun (Departments of Radiology, Seoul National University Children's Hospital, Seoul National University College of Medicine)
Bae, Eun Jung (Departments of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine)
Noh, Chung Il (Departments of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine)
Choi, Jung Yun (Departments of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine)
Yun, Yong Soo (Departments of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine)
Publication Information
Clinical and Experimental Pediatrics / v.52, no.9, 2009 , pp. 1029-1034 More about this Journal
Abstract
Kawasaki disease (KD) is an acute systemic vasculitis of unknown etiology that affects children. There are few reports that describe the Epstein-Barr virus (EBV) as the possible infectious agent of KD. Here, we describe a case of KD in a 15-year-old boy complicated with giant coronary artery aneurysms, pericardial effusion, and splenic infarction. The clinical course of KD was refractory to intravenous gamma globulin and aspirin. Our patient also showed typical findings of concomitant EBV-associated infectious mononucleosis, such as hepatosplenomegaly and generalized lymphadenopathy, with EBV-positive atypical lymphoid hyperplasia. He improved dramatically after receiving intravenous methylprednisolone followed by oral prednisolone. Ultimately, the coronary artery aneurysms remained as the only sequelae. We report a rare case of adolescent KD with EBV-associated infectious mononucleosis and splenic infarction.
Keywords
Mucocutaneous lymph node syndrome; Epstein-Barr virus infection; Coronary artery disease; Splenic infarction; Corticosteroids;
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1 Nakamura Y, Yashiro M, Uehara R, Watanabe M, Tajimi M, Oki I, et al. Use of laboratory data to identify risk factors of giant coronary aneurysms due to Kawasaki disease. Pediatr Int 2004;46:33-8   DOI   ScienceOn
2 Gupta M, Johann-Liang R, Bussel JB, Gersony WM, Lehman TJ. Elevated IgA and IgM anticardiolipin antibodies in acute Kawasaki disease. Cardiology 2002;97:180-2   DOI   ScienceOn
3 Shulman ST. Is there a role for corticosteroids in Kawasaki disease? J Pediatr 2003;142:601-3   DOI   PUBMED   ScienceOn
4 Wallace CA, French JW, Kahn SJ, Sherry DD. Initial intravenous gammaglobulin treatment failure in Kawasaki disease. Pediatrics 2000;105:E78   DOI   PUBMED   ScienceOn
5 Kanegane H, Tsuji T, Seki H, Yachie A, Yokoi T, Miyawaki T, et al. Kawasaki disease with a concomitant primary Epstein-Barr virus infection. Acta Paediatr Jpn 1994;36:713-6   DOI   PUBMED   ScienceOn
6 Dahlem PG, von Rosenstiel IA, Lam J, Kuijpers TW. Pulse methylprednisolone therapy for impending cardiac tamponade in immunoglobulin-resistant Kawasaki disease. Intensive Care Med 1999;25:1137-9   DOI   ScienceOn
7 Cho BK, Kwon SR, Yoon SJ, Chung MH, Lee SN, Lee SH. Adult-onset Kawsaki disease complicated by splenic infarction and coronary aneurysm. Korean J Infect Dis 2000;32: 388-92
8 Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics 2004;114:1708-33   DOI   PUBMED   ScienceOn
9 Thabet F, Bellara I, Tabarki B, Kchaou H, Selmi H, Yacoub M, et al. Ischemic colitis and hemophagocytosis complicating Kawasaki disease. Arch Pediatr 2004;11:226-8   DOI   ScienceOn
10 Uthman I, Khamashta M. The abdominal manifestations of the antiphospholipid syndrome. Rheumatology (Oxford) 2007;46: 1641-7   DOI   ScienceOn
11 Park YW, Han JW, Park IS, Kim CH, Cha SH, Ma JS, et al. Kawasaki disease in Korea, 2003-2005. Pediatr Infect Dis J 2007;26:821-3   DOI   ScienceOn
12 Kim NY, Choi DY, Jung MJ, Jeon IS. A case of refractory Kawasaki disease complicated by peripheral ischemia. Pediatr Cardiol 2008;29:1110-4   DOI   ScienceOn
13 van Hal S, Senanayake S, Hardiman R. Splenic infarction due to transient antiphospholipid antibodies induced by acute Epstein-Barr virus infection. J Clin Virol 2005;32:245-7   DOI   ScienceOn
14 Huong DL, Gatfosse M, Papo T, Barjonet G, Lacombe P, Godeau P. Symptomatic splenic infarction complicating adult Kawasaki disease. Br J Rheumatol 1995;34:579-80   DOI   PUBMED
15 Pitetti RD, Laus S, Wadowsky RM. Clinical evaluation of a quantitative real time polymerase chain reaction assay for diagnosis of primary Epstein-Barr virus infection in children. Pediatr Infect Dis J 2003;22:736-9   DOI   PUBMED   ScienceOn
16 Muta H, Ishii M, Sakaue T, Egami K, Furui J, Sugahara Y, et al. Older age is a risk factor for the development of cardiovascular sequelae in Kawasaki disease. Pediatrics 2004; 114:751-4   DOI   ScienceOn
17 Song D, Yeo Y, Ha K, Jang G, Lee J, Lee K, et al. Risk factors for Kawasaki disease-associated coronary abnormalities differ depending on age. Eur J Pediatr [Epub ahead of print] 2009 Jan 22. Available from: URL://http://www. springerlink.com/content/100415/
18 Tabarki B, Mahdhaoui A, Selmi H, Yacoub M, Essoussi AS. Kawasaki disease with predominant central nervous system involvement. Pediatr Neurol 2001;25:239-41   DOI   ScienceOn
19 Kikuta H, Nakanishi M, Ishikawa N, Konno M, Matsumoto S. Detection of Epstein-Barr virus sequences in patients with Kawasaki disease by means of the polymerase chain reaction. Intervirology 1992;33:1-5   DOI   PUBMED
20 Muso E, Fujiwara H, Yoshida H, Hosokawa R, Yashiro M, Hongo Y, et al. Epstein-Barr virus genome-positive tubulointerstitial nephritis associated with Kawasaki disease-like coronary aneurysms. Clin Nephrol 1993;40:7-15   PUBMED
21 Beiler HA, Schmidt KG, von Herbay A, Loffler W, Daum R. Ischemic small bowel strictures in a case of incomplete Kawasaki disease. J Pediatr Surg 2001;36:648-50   DOI   ScienceOn