Letters to the Editor
To the Editors:
Kawasaki disease (KD) is one of the most common vasculitides of childhood.1 The cause of KD remains unknown, but it is thought that the immune system is activated by infectious or environmental triggers in genetically susceptible hosts.1 Although some patients with postvaccination KD have been described,2,3 patients with postinfluenza vaccination KD have never been reported. Herein, we describe the case of a patient with postinfluenza vaccination KD.
A previously healthy, 2-year-old girl was brought for evaluation because of a high-grade fever. The girl had received 2 doses of the influenza vaccine 36 and 8 days before the onset of fever. Because she subsequently exhibited right cervical lymphadenopathy and bilateral conjunctival injection of 4 days’ duration, she was admitted to our hospital.
The body temperature was 38.7°C at the time of admission. The physical examination revealed bilateral conjunctival injection, truncal erythema, erythema and edema of the hands bilaterally, right cervical lymphadenopathy and injected lips. Laboratory testing revealed leukocytosis (white blood cell count = 24,500/μL) with increased immature forms, an elevated C-reactive protein (14.46 mg/dL) and hyponatremia (sodium = 131 mEq/L). Based on these findings, the patient was diagnosed with KD. Intravenous immunoglobulin therapy (2 g/kg/dose) for 1 day and oral administration of aspirin (30 mg/kg per day) resulted in rapid improvement of the KD signs and of abnormal laboratory test results. She remains well without coronary artery abnormalities 2 months after the onset of the present illness.
Our patient developed postinfluenza vaccination KD. Post-hepatitis B2 and yellow fever3 vaccination KD have been reported. Although postinfluenza vaccination KD has not been reported, it is well known that influenza vaccination can cause various types of vasculitides, such as ANCA-associated vasculitis4 and Henoch–Schönlein purpura,5 the so-called “postinfluenza vaccination vasculitides.”4 Although the mechanism underlying the development of influenza vaccine-induced vasculitides is unknown, a possible link between influenza vaccination and autoimmunity has been suggested.4 Because an activated immune system following infectious or environmental stimulation contributes to the development of KD,1 influenza vaccination possibly served as a trigger for the development of KD in our patient.
Shuichiro Shimada, MD
Toru Watanabe, MD, PhD
Seiichi Sato, MD, PhD
Department of Pediatrics
Niigata City General Hospital
Niigata City, Japan
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3. Schmöeller D, Keiserman MW, Staub HL, et al. Yellow fever vaccination and Kawasaki disease. Pediatr Infect Dis J. 2009;28:1037–1038
4. Zafrir Y, Agmon-Levin N, Shoenfeld Y.. Post-influenza vaccination vasculitides: a possible new entity. J Clin Rheumatol. 2009;15:269–270
5. Watanabe T.. Henoch-Schönlein purpura following influenza vaccinations during the pandemic of influenza A (H1N1). Pediatr Nephrol. 2011;26:795–798