Discrimination of Kawasaki disease with concomitant adenoviral detection differentiating from isolated adenoviral infection

Kim, Jong Han; Kang, Hye Ree; Kim, Su Yeong; Ban, Ji-Eun

This study demonstrated the clinical and laboratory characteristics of KD with incidental adenoviral detection that may help differentiate isolated adenoviral infection. Although the clinical features of adenovirus-positive KD are similar to an isolated adenoviral infection, adenoviral-positive KD usually had frequent lip and tongue change, skin rash and changes in extremities compared to adenoviral infection. However, cervical lymphadenopathy was not differently observed between the 2 groups. In the present study, CRP, hypoalbuminemia and sterile pyuria could be differentiated between the adenovirus-positive KD group and adenoviral infection group. In addition, the cutoff CRP level of 56 mg/L aids in the discrimination of diagnosis of KD from adenoviral infection. This distinct clinical and laboratory pattern was characteristic of adenovirus positive KD. However, high CRP level could also be observed in adenoviral infection with secondary bacterial infection. Although the American Heart Association guidelines suggest that a CRP ≥30 mg/L or ESR ≥40 mm/hr may consider incomplete KD 15) , a recent study demonstrated that a CRP ≥30 mg/L has a lack specificity for KD. Additionally, a higher CRP ≥70 mg/L suggesting the discrimination of KD from adenoviral infection was consistently observed in the KD group 14) .