A Pediatric Illness with a Rare Adult Presentation
Kawasaki disease (KD) is a form of vasculitis, or inflammation of the blood vessels, predominantly found in children. Its characteristic symptoms include a prolonged, high fever and a cluster of other signs like rash, red eyes, and swollen lymph nodes. Because of its rarity in adults, the disease is often overlooked or misdiagnosed, which can result in more severe outcomes due to delayed treatment. A case of a 75-year-old man with incomplete KD serves as a stark reminder that this condition must be considered in patients of any age who present with persistent fever and inflammatory symptoms.
Why Adult Kawasaki Disease is a Diagnostic Challenge
The rarity of adult-onset KD means that healthcare providers may not immediately consider it as a possibility, especially when symptoms don't perfectly align with the established pediatric criteria. Studies show that the presentation can differ significantly between children and adults, further complicating diagnosis. In adults, symptoms may evolve sequentially rather than appearing all at once, mimicking more common viral infections, autoimmune disorders, or other forms of vasculitis. For example, adults with KD are more likely to experience hepatitis, arthralgia (joint pain), and significant cervical lymphadenopathy compared to children. The absence of a specific diagnostic test means the diagnosis relies on careful clinical evaluation and the exclusion of other diseases.
The Critical Importance of Timely Diagnosis
Delayed or incorrect diagnosis is the primary reason adult KD carries a higher risk of serious, long-term complications. Early treatment is crucial for reducing the risk of coronary artery aneurysms. When treatment is delayed beyond the critical window (often within 10 days of fever onset), the likelihood of developing these cardiac issues increases significantly. For adults, this delay can be even longer due to the misleading nature of the symptoms and the lower index of suspicion.
How Symptoms in Adults Differ from Children
| Symptom | Presentation in Children | Presentation in Adults |
|---|---|---|
| Cervical Lymphadenopathy | Present in about 75% of children; often unilateral. | More frequent and prominent, reported in up to 93% of cases. |
| Hepatitis | Occurs in roughly 10% of pediatric cases. | Much higher incidence, with some studies reporting up to 65% of adult cases. |
| Arthralgia | Common but less frequent, affecting 24-38% of children. | More frequent and pronounced, occurring in over 60% of cases. |
| Coronary Artery Aneurysms | Untreated rate up to 25%; treated rate reduced to <5%. | Less frequent initially, but delayed diagnosis and treatment can increase risk. |
| Meningitis | Occurs in up to 34% of children. | Significantly less frequent, found in only 10% of adult cases. |
| Thrombocytosis | Almost universally present during the subacute phase. | Present in about 55% of adult cases, less reliable as a marker. |
Managing Adult-Onset Kawasaki Disease
Once diagnosed, the management of adult KD follows a similar path to pediatric treatment, though long-term monitoring is often more intensive, especially if cardiac complications arise.
- Hospitalization and Acute Treatment: All patients with suspected KD should be hospitalized. The standard treatment involves therapies aimed at reducing inflammation and managing symptoms. This treatment should begin as soon as possible after diagnosis.
- Long-Term Cardiac Monitoring: Because of the heightened risk of coronary artery damage, long-term follow-up with a cardiologist is essential. This includes regular echocardiograms, stress tests, and other imaging to monitor for aneurysms, stenosis, or other vascular issues.
- Medication Management: Patients who develop cardiac complications may require ongoing medication. This could include therapies to prevent blood clots or support blood vessel health.
- Lifestyle Modifications: Adopting a heart-healthy lifestyle, including a balanced diet and regular exercise (as advised by a doctor), is crucial for managing the long-term risk of cardiovascular disease.
For more information on the diagnosis and management of Kawasaki disease in various age groups, the American Heart Association provides comprehensive guidelines and statements. You can read more about them here: American Heart Association Guidelines for Kawasaki Disease.
The Importance of Awareness and Proactive Care
The rising number of adults living with previous KD highlights the need for a collaborative approach between pediatric and adult cardiologists. With improved recognition and management, the long-term prognosis for adults with KD can be improved. However, the first step is for healthcare professionals to maintain a high index of suspicion and for individuals to be aware of the possibility of this rare condition.
Supporting an Adult with Kawasaki Disease
Providing support for an adult with KD goes beyond medical treatment and involves emotional and practical support. Given the rarity of the diagnosis in this age group, patients may feel isolated or face disbelief from others.
- Educate Yourself: Learn as much as you can about the disease, its course, and its potential long-term effects. This will help you understand what the patient is experiencing.
- Advocate for Timely Care: Help the individual communicate with their doctors, particularly when symptoms are atypical. Ensure all follow-up appointments with cardiologists are kept.
- Encourage a Heart-Healthy Lifestyle: Support them in making positive lifestyle changes, such as maintaining a healthy diet and incorporating gentle, physician-approved exercise into their routine.
- Offer Emotional Support: Acknowledge their frustrations and fears. Connect them with support groups or online forums where they can speak to other adults who have experienced KD.
By increasing awareness and providing comprehensive support, we can improve the diagnostic journey and long-term outcomes for older people who get Kawasaki disease.
