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

Ueda, Yuki; Kenzaka, Tsuneaki; Noda, Ayako; Yamamoto, Yu; Matsumura, Masami

Computed tomography of the chest and abdomen revealed hepatic and splenic enlargement and fatty liver. A skin biopsy of the erythema on the left forearm showed lymphocyte infiltrations around vessels in the superficial layer of the epidermis. There were no findings suspected for vasculitis or drug allergy. The patient had fever for .5 days, and four additional principal signs indicative of KD based on the diagnostic criteria defined by the Centers for Disease Control and Prevention, 8 namely exanthema, change in peripheral extremities, bilateral non-exudative conjunctival injection, and changes in the oropharynx, on the basis of which he was clinically diagnosed with KD. On the day of admission, he was treated with 2,700 mg/day of oral aspirin (30 mg/kg/day). On day 4, the dose of aspirin was reduced to 450 mg/day (5 mg/kg/day) because of defervescence; however, on day 5, the patient developed liver dysfunction as an adverse effect of aspirin. After day 6 in our hospital, the myalgia, congested conjunctivae, erythema, and desquamations were found to be gradually resolving. By day 13, the erythema and desquamation were completely resolved. However, the treatment was switched from aspirin to 200 mg/day of cilostazol because the alanine aminotransferase levels increased to 150 U/L ( Figure 2 ). Subsequently, the liver function normalized, and the patient was discharged on the 13th hospital day. During hospitalization, transthoracic echocardiography disclosed no coronary aneurysms. At follow-up, coronary computed tomography performed 2 months after the onset of the disease revealed no coronary aneurysms ( Figure 3 ).