26 July, 2008

Kawasaki disease

Typical face of Kawasaki disease: strawberry tongue, red &
cracked lips, red eyes and skin rash.
Edema & erythema of hand, skin rashes
Edema & erythema of foot, maculo-rash also noted.
Skin desquamation(peeling) begin fingertips at convalescent stage

In 1967, Dr. Tomisaku Kawasaki(Japanese Red Cross Central Hospital of Tokyo)
reported the first cases of Kawasaki disease in a Japanese Journal(1). I think,
this paper is one of the best papers in clinical medicine. He described in the
details of the symptoms, signs and clinical course of patients with many photos.

Later, in 1974, he reported a paper of MLNS(=Kawasaki disease) in the official
Journal of American Academy of Pediatrics(2). However, this English version
was not well described, as comparing to the Japanese one.

Since started as pediatrician in 1975, I have been interesting the etiology of
Kawasaki disease. One day in 1992, Human herpesvirus-6 was isolated from
blood sample of 4-month-old patients, but not another patients(3). The case
might have been co-incidental.

Today in Japan, the total numbers of patients is around 6.000 ~ 9,000 cases/year.
The searches for the causative microbe such as bacterias, viruses and fungus
have been failed.

1) Kawasaki T.,: Febrile ocuro-oro-cutaneous -acrodesquamatous syndrome
with or without acute non-suppurative cervical lymphadenitis in infancy and
childhood : clinical observations of 50 cases.
Jap.J.Allergy 16(39:178-222, 1967. ( in Japanese)
2) Kawasaki T, Kosaki F, Okawa S, Shigematsu I, Yanagawa H.: A new
infantile acute febrile Mucocutaneous lymph node syndrome(MLNS)
prevailing in Japan. Pediatrics 54(3);271-276,1974.
3) Hagiwara K, Yoshida T, Komura H, Kishi F, Kajii T.,: Isolation of
human herpesvirus-6 from an infant with Kawasaki disease.

Any questions: write to Keiji Hagiwara MD,
E-mail: keijihagiwara@gmail.co