Abstract 195: Kawasaki Disease in a four-year-old girl with History of Acute Myeloid Leukemia; Report of a Case and Literature Review

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Abstract

Background: Kawasaki disease (KD) and acute myeloid leukemia (AML) both occur predominantly in young children. However, considering that the incidence rate of cancer during 0-14 years of age in Japan is 10.1 per a hundred thousand and that of KD during 0-4 years of age is 260 per a hundred thousand, there is little possibility of the same individual developing 2 diseases. Both inside and outside Japan we found at least 19 case reports of KD some relevant to cancer. Herein, we report a case of KD in a four-year-old Japanese girl with history of AML.

Case report: A four-year-old Japanese girl was diagnosed with KD at 3 days of illness. She had the medical history of AML-M7 at her age of 1. She had no chimeric genes and was classed as intermediate risk. She had been treated following JPLSG AML05 protocol including etoposide, cytarabine (Ara-C), mitoxantrone, idarubicin, methotrexate (MTX), hydrocortisone (HDC) and triple intrathecal therapy (Ara-C, MTX and HDC). More than 2 years had passed without recurrence since her last chemotherapy. When we diagnosed her as KD, laboratory findings showed WBC 15.5 х103/μl with 85% neutrophils, hematocrit 33.7%, platelet count 19.1x106/μl, CRP 10.5mg/dl, serum albumin 3.8g/dl and BNP 12.2pg/ml. She responded well to IVIG (2g/kg) plus prednisolone (2mg/kg/day) and ASA (30mg/kg/day). Although BNP transiently had increased to 151.8pg/ml at 5 days after onset, neither coronary arterial abnormalities nor myocardial complications were detected at 1 year of illness.

Conclusions: We experienced the rare case of KD in a four-year-old Japanese girl with history of AML. She responded well to IVIG and any cardiovascular complications were not detected at 1 year of illness. Referring to only this case, it is unclear whether the history of AML could influence developing and progress of KD or not. The possibility of the same individual developing KD during 0-4 years of age and cancer during 0-14 years of age would be 2.6 per 10 million in Japan. However, among three hundred thousand cumulative patients of KD in Japan, 14 cases have been reported that they had developed cancer during 0-14 years of age. To discuss the relation to character of cancer, chemotherapy and severity or compilations of KD, more case should be evaluated.

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