Kawasaki disease: a report of 26 patients

[Pathology of large vessel vasculitides]

INTRODUCTION

Vasculitides can be classified according to the size of the involved vessels. The pathological patterns of large vessel vasculitides are presented here.

CURRENT KNOWLEDGE AND KEY POINTS

They concern Buerger's disease, temporal arteritis, Takayasu's disease, Behçet's disease, infectious arteritides, rheumatologic and miscellaneous diseases. Buerger's disease is a thrombotic arteriopathy with no arterial wall involvement. Temporal arteritis and Takayasu's disease belong to the group of giant cell arteritides. In temporal arteritis, the inflammation is prominent in the internal part of the media and is aggressive for the arterial wall. In Takayasu's disease, the external part of the media is prominently involved. The fibrous thickening of the arterial wall with stenosis is characteristic. Behçet's disease can involve the large arteries with a risk of arterial rupture. Infectious arteritides are not unfrequent in vascular surgery and in previous arterial lesions. Rheumatologic diseases can result in aortitis with aortic incompetence.

FUTURE PROSPECTS AND PROJECTS

These diseases have pathological characteristics which contribute to diagnosis. However, a clearcut classification of vasculitides will come from the precise knowledge of their etiology.

Kawasaki syndrome

Kawasaki syndrome is an acute multisystem inflammatory disease of young children first described by Tomasaku Kawasaki in the Japanese literature in 1967. He reported 50 cases of this entity under the rubric of acute febrile mucocutaneous lymph node syndrome, a designation that has more recently been superseded by the eponym Kawasaki syndrome. The disorder was further delineated and brought to the attention of American pediatricians in 1974. Recognition of the syndrome followed rapidly, and Melish, Hicks and Larson published the first series of American cases from Hawaii in 1976. Subsequently, Kawasaki syndrome has been documented worldwide. Although the disorder is known to be a systemic vasculitis with predilection for the coronary arteries, the etiology has remained obscure despite intense investigative efforts.

Does Kawasaki disease have a retroviral aetiology?

In 18 consecutive children with Kawasaki disease of recent onset, reverse transcriptase (RT) activity was studied in co-cultivated peripheral-blood-mononuclear-cell/lymphoblastoid-cell supernatants. 8 of 18 children, but only 1 of 18 controls, showed RT activity in one or more sample (p = 0.009). RT activity was identified in 14 of 226 samples from patients, but in only 1 of 167 from controls (p less than 0.01). The findings suggest that a retroviral agent may be casually related to Kawasaki disease.