Primary Cytomegalovirus Infection, Atypical Kawasaki Disease, and Coronary Aneurysms in 2 Infants

Abstract

We describe 2 infants who developed atypical Kawasaki disease and coronary aneurysms during primary cytomegalovirus infection. These observations suggest that children with coronary aneurysms and Kawasaki-like disease should be tested for cytomegalovirus. Conversely, children with unusually severe primary cytomegalovirus infection should be tested for coronary aneurysms.

Kawasaki disease: Aetiopathogenesis and therapeutic utility of intravenous immunoglobulin

“…Changes in the oral cavity, including strawberry tongue erythematous, fissured lips and injected pharynx Changes in the peripheral extremities, including erythema or indurative oedema and later desquamation Cervical lymphadenopathy, often unilateral and large (≥1.5 cm) Epstein-Barr virus or cytomegalovirus, toxic shock syndrome toxin 1 and other bacterial toxins, Coronavirus NL-63, Human bocavirus, and previously unrecognized persistent RNA virus. However, none of the above aetiological features has been confirmed by subsequent studies [14,[23][24][25][26][27][28][29][30][31][32][33][34].…”

Aortic conduit aneurysm and enteric fistula formation in a post–liver transplant patient: A potential causative role for cytomegalovirus?

“…16 authors did however acknowledge that the timing and use of IgM to diagnose CMV infection may be confounded by the upregulation of IgM to previous pathogens, which has been previously described in Kawasaki's disease. 17 We have speculated a role for CMV in the etiology of our patient's arterial conduit aneurysm. There are however some limitations in this case which we acknowledge.…”

“…They concluded that CMV infection may have had a role in the development of an atypical Kawaski's disease. The authors did however acknowledge that the timing and use of IgM to diagnose CMV infection may be confounded by the upregulation of IgM to previous pathogens, which has been previously described in Kawasaki's disease …”

Kawasaki syndrome and concurrent Coxsackie virus B3 infection

“…Esper et al reported the association between the new human coronavirus NL-63 and KS, detecting the virus by reverse transcription-polymerase chain reaction in respiratory samples from 8 of 11 infants with KS [21], though this association was disavowed in further studies [22]. Catalano-Pons et al have reported 2 infants with incomplete KS and coronary aneurysms during primary Cytomegalovirus infection, in whom intravenous ganciclovir improved both clinical and echocardiographic abnormalities, while IVIG were ineffective [23]. In 2005, Benseler et al have evaluated retrospectively the rate of concurrent infections at the time of KS diagnosis in a cohort of 129 children during a 2-year period: they found that various infections (tonsillitis with positive throat culture for group A Streptococcus, viral illnesses confirmed by the evidence of serologic positive IgM antibody, chest radiograph-proven pneumonias, urinary tract infections, gastroenteritis and/or sepsis) were present in 33% of patients, though no infection influenced the response to IVIG, similarly to the apparently uninfected patients [24].…”