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Kawasaki Disease With Thrombocytosis Followed by Thrombocytopenia Purpura in the Same Patient FREE

ROBERT N. LIPNICK, MD; NAOMI L.C. LUBAN, MD
Am J Dis Child. 1989;143(2):139-140. doi:10.1001/archpedi.1989.02150140021008.
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Sir.—Kawasaki disease has been commonly associated with numerous hematologic abnormalities, including anemia, leukocytosis, thrombocytosis, and enhanced platelet aggregation.1 However, thrombocytopenia has, to our knowledge, not been previously described. We describe a patient with Kawasaki disease who developed idiopathic thrombocytopenia purpura (ITP).

Patient Report.—A 9-year-old boy was in excellent health until he presented with an erythematous rash and spiking fever of six days' duration, arthralgias involving his hips and ankles, headache, and sore throat. The patient denied any history of cough, rhinorrhea, shortness of breath, nausea, vomiting, or other complaints. He had moved to the area from Colorado two weeks prior to admission and denied contact with any animals, chemicals, or other substances. The patient's medical history was unremarkable and he reported no allergies. The patient was admitted to the hospital and treated with cefuroxime for two days, but continued with high intermittent fever and was transferred to

REFERENCES

Hicks RV, Melish ME:  Kawasaki syndrome . Pediatr Clin North Am 1986;; 33:1151-1175.
Bell DM, Morens DM, Holman RC, et al:  Kawasaki syndrome in the United States . AJDC 1983;; 137:211-214.
Shulman ST, Rowley AH:  Does Kawasaki disease have a retroviral aetiology? Lancet 1986;;2: 545-546.
Mason WH, Jordan SC, Sakai R, et al:  Circulating immune complexes in Kawasaki syndrome . Pediatr Infect Dis J 1985;;4:48-51.
Levin M, Holland PC, Nokes TJ, et al:  Platelet immune complex interaction in pathogenesis of Kawasaki disease and childhood polyarteritis . Br Med J 1985;;290:1456-1460.
Haakenstad AO, Mannik M:  Saturation of the reticuloendothelial system with soluble immune complexes . J Immunol 1974;;112:1939-1948.
Burns J, Glude MP, Clark SH, et al:  Coagulopathy and platelet activation in Kawasaki syndrome: Identification of patients at high risk for development of coronary artery aneurysms . J Pediatr 1984;;105:206-211.
Loomis K, Kickler TS, Sears D, et al:  A simplified radioimmunoassay for antibodies causing immune cytopenia . Am J Clin Pathol 1985;; 83:12-17.
Drug Information 88: American Hospital Formulary Service . Bethesda, Md, American Society of Hospital Pharmacist, 1988;.
Myllyla G, Vaheri A, Uesikari T, et al:  Interaction between human platelets, viruses, and antibodies in postrubella thrombocytopenic purpura and platelet aggregation by rubella antigen-antibody interaction . Clin Exp Immunol 1969;;4:323.

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References

Hicks RV, Melish ME:  Kawasaki syndrome . Pediatr Clin North Am 1986;; 33:1151-1175.
Bell DM, Morens DM, Holman RC, et al:  Kawasaki syndrome in the United States . AJDC 1983;; 137:211-214.
Shulman ST, Rowley AH:  Does Kawasaki disease have a retroviral aetiology? Lancet 1986;;2: 545-546.
Mason WH, Jordan SC, Sakai R, et al:  Circulating immune complexes in Kawasaki syndrome . Pediatr Infect Dis J 1985;;4:48-51.
Levin M, Holland PC, Nokes TJ, et al:  Platelet immune complex interaction in pathogenesis of Kawasaki disease and childhood polyarteritis . Br Med J 1985;;290:1456-1460.
Haakenstad AO, Mannik M:  Saturation of the reticuloendothelial system with soluble immune complexes . J Immunol 1974;;112:1939-1948.
Burns J, Glude MP, Clark SH, et al:  Coagulopathy and platelet activation in Kawasaki syndrome: Identification of patients at high risk for development of coronary artery aneurysms . J Pediatr 1984;;105:206-211.
Loomis K, Kickler TS, Sears D, et al:  A simplified radioimmunoassay for antibodies causing immune cytopenia . Am J Clin Pathol 1985;; 83:12-17.
Drug Information 88: American Hospital Formulary Service . Bethesda, Md, American Society of Hospital Pharmacist, 1988;.
Myllyla G, Vaheri A, Uesikari T, et al:  Interaction between human platelets, viruses, and antibodies in postrubella thrombocytopenic purpura and platelet aggregation by rubella antigen-antibody interaction . Clin Exp Immunol 1969;;4:323.

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