Indian Pediatr 2015;52: 443-444
Recurrence of Kawasaki Disease: Authors’
Department of Pediatrics, Peoples campus,Bhanpur,
We agree that during the second episode, coronary arteries were normal
and rise in acute phase reactants was not very impressive in our
patient. However, our case satisfied the criteria of incomplete Kawasaki
disease during recurrence [1,2].
1. In our case, peeling of skin of sole occurred
2-3 weeks after the acute illness, that further supported the
diagnosis, and does not indicate that skin peeling was mandatory for
diagnosing the Kawasaki disease.
2. Broderick, et al.  reported
recurrent fever in four patients with a history of Kawasaki disease.
They had periodic fever ocurring at regular intervals (2-6 weeks)
and two of them were also having aphthous stomatitis. Fever was
associated with rash in two children, but skin desquamation was
missing in all these children with recurrent fever. In our child,
there was no such history. However, we agree that recurrent fever
syndromes should be considered, and needs to be excluded before
labelling the case as recurrent Kawasaki disease.
3. In scarlet fever, the skin may start to peel
even during the febrile stage. This peeling starts cephalo-caudally,
and lastly palms and soles. In Kawasaki disease, sheet like skin
peeling is characteristically limited to the palms and soles, as in
our case. We agree that skin desquamation is not pathognomonic of
4. It is true that disease recurrence results in
additional coronary artery involvement, but we had administered
intravenous immunoglobulins early in the course of disease that
probably prevented coronary artery involvement .
1. Newburger JW, Takahashi M, Gerber MA, Gewitz MH,
Tani LY, Burns JC, et al. American Heart Association Scientific
Statement – Diagnosis, treatment, and long-term management of Kawasaki
disease. Circulation. 2004;110:2747-71.
2. Witt MT, Luann ML, Bohnsack JF, Young PC. Kawasaki
disease: More patients are being diagnosed who do not meet American
Heart Association criteria. Pediatrics. 1999;104:10.
3. Broderick L, Tremoulet AH, Burns JC, Bastian JF,
Hoffman HM. Recurrent fever syndromes in patients after recovery from
Kawasaki syndrome. Pediatrics. 2011; 127:e489-93.
4. Rowley AH, Duffy CE, Shulman ST. Prevention of
giant coronary artery aneurysms in Kawasaki disease by intravenous
gammaglobulin therapy. J Pediatr. 1988;113:290-4.