Kawasaki disease is an illness that causes inflammation in blood vessels throughout the body, primarily affecting the coronary arteries that supply blood to the heart. This condition is most often recognized in young children, particularly those under five years of age. Although its exact cause remains unknown, it is considered a form of vasculitis.
Prevalence in Adults
While Kawasaki disease is predominantly observed in young children, it can occur in adults, though such cases are exceptionally rare. Some adults are diagnosed later in life, sometimes only after heart complications emerge, revealing a previously undiagnosed childhood history. Its prevalence among adults is significantly lower than in the pediatric population, representing a tiny fraction of total cases.
Adult-onset Kawasaki disease is not only rare but also often presents diagnostic challenges due to its atypical nature. Its occurrence in adults underscores the importance of considering this diagnosis even outside the typical childhood age range.
Recognizing Kawasaki Disease in Adults
Recognizing Kawasaki disease in adults can be complex because symptoms may be subtle, atypical, or overlap with other conditions. Common symptoms often mirror those seen in children, including a persistent fever lasting five days or more. Other signs include a widespread rash, red eyes, and swollen lymph nodes, often in the neck.
Characteristic changes in the mouth include red, cracked lips and a red, bumpy “strawberry” tongue. Swelling and redness of the hands and feet, sometimes followed by peeling skin, are additional indicators. Adults may also experience joint pain or inflammation, which can be more prominent than in pediatric cases.
Adults with Kawasaki disease might present with certain features more frequently than children, such as cervical lymphadenopathy and hepatitis. The general nature of these symptoms can lead to misdiagnosis, as they resemble common viral infections, rheumatoid arthritis, or lupus, potentially delaying proper treatment.
Diagnosis and Management for Adults
Diagnosing Kawasaki disease in adults relies primarily on clinical criteria, as there is no single specific test. A diagnosis is typically made when a patient experiences a fever for at least five days, accompanied by at least four of the five principal clinical findings:
Bilateral conjunctivitis
Changes in the lips and oral cavity
Cervical lymphadenopathy
Extremity changes
Polymorphous rash
If fewer than four criteria are met but inflammation is present, it may be considered incomplete Kawasaki disease.
Blood tests can reveal inflammation markers like elevated erythrocyte sedimentation rate and C-reactive protein, which support the diagnosis. An echocardiogram, an ultrasound of the heart, is a crucial tool to assess for potential heart involvement, particularly coronary artery abnormalities. Early diagnosis and treatment are important to reduce complication risks.
The primary treatment for acute Kawasaki disease involves intravenous immunoglobulin (IVIG) and aspirin. IVIG aims to reduce acute inflammation and significantly lowers the risk of coronary artery aneurysms. Aspirin is given for its anti-inflammatory and antiplatelet effects. These treatments are typically administered in a hospital setting.
Long-Term Health Considerations
For adults who have experienced Kawasaki disease, especially those with a childhood history, long-term health considerations primarily involve cardiovascular health. The most serious potential complication is the development of coronary artery aneurysms, which are weakened areas in the artery walls. These can lead to issues such as blood clots, narrowing of arteries, or, in rare cases, heart attack.
Even if aneurysms regress, the affected coronary arteries may become stiffer or develop other abnormalities over time. Individuals with a history of Kawasaki disease, particularly those with past coronary artery involvement, require ongoing monitoring and follow-up care. Managing traditional cardiovascular risk factors, such as high blood pressure or cholesterol, is especially important to maintain heart health.