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Indian Pediatr 2015;52: 443

Recurrence of Kawasaki Disease: Look Before you Leap on the Bandwagon

Mani Ram Krishna

Dr RK Nursing Home, Shivaji Nagar, Thanjavur, Tamil Nadu, India.
Email: mann_comp@hotmail.com


Verma and colleagues reported an interesting case of recurrent fever of immunological origin [1]. The first episode probably favors a diagnosis of Kawasaki disease because of the presence of coronary artery dilatation, which normalized with anti-inflammatory therapy. During the second episode, the child had high-grade fever with oral mucosal changes and cervical lymphadenopathy with no identifiable infective cause on basic laboratory evaluation. The coronary arteries were normal. The rise in acute phase reactants was not very impressive. It seems reasonable to consider Kawasaki disease among the differential diagnosis of this condition, but the following issues need reconsideration:

1. A lot of emphasis has been given to skin desquamation. Episodes of skin desquamation during febrile episodes have been reported even beyond 5 years from the initial episode of Kawasaki disease [2]. Hence caution should be exercised in considering skin desquamation in diagnosing disease recurrence.

2. Recurrent fevers with features of generalized inflammation after Kawasaki disease might represent patients with a genetic predisposition to inflammatory disorder [3].

3. Skin desquamation cannot be considered pathognomonic of Kawasaki disease. It is a feature of many infectious and immunological diseases, including Scarlet fever [4] and Leptospirosis. The skin desquamation in Kawasaki disease is generally limited to the palms and soles and severe peeling in sheets occurs only in a small proportion of patients.

4. The lower risk of disease recurrence in India more likely points to the lack of proper disease reporting systems. Experience suggests that recurrence commonly occurs in children who suffered a more severe disease with coronary artery involvement at initial presentation [3]. The disease recurrence frequently results in additional coronary involvement.

This essentially highlights that the lack of a confirmatory laboratory test leaves us reliant on clinical criteria for diagnosis of Kawasaki disease. Recent work on the pathogenesis of the vasculitics gives hope that a solution for this complex problem may be on the way sooner than later.


1. Verma P, Agarwal N, Maheshwari M. Recurrent Kawasaki disease. Indian Pediatr. 2015;52:152-4.

2. Michie C, Kinsler V, Tulloh R, Davidson S. Recurrent skin peeling following Kawasaki Disease. Arch Dis Child. 2000;83:353-5.

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. Gerber MA. Group A Streptococcus In: Kliegman RM, Stanton BF, Geme JW, Schor NF, editors. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Elsevier; 2011.

5. Balasubramanian S, Krishna MR, Dhanalakshmi K, Amperayani S, Ramanan AV. Factors associated with delay in diagnosis of Kawasaki disease in India. Indian Pediatr. 2012;49:663-5.


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