Cardiac Involvement and Prognosis in Acute Mucocutaneous Lymph Node Syndrome

Onouchi, Zenshiro; Tomizawa, Nobuyuki; Gotō, Masakatsu; Nakata, Kazuyasu; M, Fukuda

doi:10.1378/chest.68.3.297

Cited by 61 publications

(17 citation statements)

References 8 publications

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“…After HS infusion, immediate leukopenia followed by leukocytosis we noted in the present study was similar to that reported by Onouchi et al (16,30). Immediately after the HS infusion, platelets were also significantly decreased and then increased, likewise in KD, as noted by Levin et al (31).…”

Section: Discussionsupporting

confidence: 92%

A Swine Model of Horse Serum-Induced Coronary Vasculitis: An Implication for Kawasaki Disease

et al. 2004

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An attempt was made to induce immune complex vasculitis by horse serum (HS) infusions in piglets, hoping to produce experimental coronary artery lesions that mimic Kawasaki disease. A total of 21 purebred male piglets of 1.5, 2.5, and 3 mo were divided into HS (n ϭ 14) and control, normal saline (NS; n ϭ 7) groups. In seven piglets, 5 mL/kg of HS was infused, then repeated with 10 mL/kg 10 d later. In another seven piglets, 10 mL/kg of HS was infused three times at 5-d intervals. In three piglets in the control group, 5 and 10 mL/kg of NS was infused at 10-d intervals. In another four piglets of the control group, 10 mL/kg of NS was infused three times at 5-d intervals. Twodimensional echocardiographic examinations for visualization and measurement of the coronary arteries were done before and after infusions at 4-to 5-d interval. Hematology examination showed that white blood cells and platelets decreased, then increased. The animals were killed at 14 -60 d after the first infusion of HS or NS, for histopathologic and immunohistochemical studies. All HS groups developed skin rashes and echocardiographic evidence of coronary artery dilation and histopathologic changes of vasculitis. None in the NS group developed vasculitis. The main changes of the coronary vasculitis were intimal proliferation, smooth muscle cell necrosis, and vacuolization changes. Those that received three HS infusions developed more skin rashes than those that received two infusions. It is concluded that piglets may serve as an experimental model for immune complex vasculitis involving the coronary arteries with skin rashes mimicking Kawasaki disease. Kawasaki disease (KD), an acute self-limiting systemic vasculitis of unknown origin, has become a leading cause of acquired heart disease other than rheumatic heart disease in many developed countries (1-3). Coronary artery lesions (CALs) with aneurysmal dilation, thrombosis, and/or stenosis, leading to myocardial infarction and death, have been recognized as the most severe complication (4, 5). Circulating immune complexes (ICs), triggered by infectious agents, bacteria, or viral or other unknown cause, have been detected in the early phase of KD, implicating that immunopathologic mechanisms might be involved in the pathogenesis of vasculitis in KD (6 -10). Attempts to produce coronary vasculitis have been made in mice, weanling rabbits, and guinea pigs by injecting infectious agents, foreign proteins, and Lactobacillus casei cell walls (11-15). Coronary arteritis was induced in weanling rabbits by injecting horse serum (HS) (16). Swine is a unique and promising animal for biomedical research, especially in the field of cardiovascular diseases (17, 18). IC coronary vasculitis, however, was never produced in swine. We tried, therefore, to induce coronary vasculitis in piglets, hoping that CAL mimicking KD could be produced. This study was designed to observe the skin and systemic reactions and hematologic changes, measure the coronary artery diameters by echocardiography, and examine the histop...

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Section: Discussionsupporting

confidence: 92%

A Swine Model of Horse Serum-Induced Coronary Vasculitis: An Implication for Kawasaki Disease

et al. 2004

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“…Since KD was first described by Kawasaki in 1967, many clinical, histopathological and or molecular biological studies have been performed to investigate the pathophysiology of the vascular involvement of KD; however, the underlying mechanism remains unclear [2,3,8,9]. Coronary arteritis in KD is considered to begin with edematous changes in the media, developing into inflammatory changes in the intima and adventitia, which finally evolve into the panvasculitis observed during autopsies [8].…”

Section: Introductionmentioning

confidence: 99%

The involvement of the vasa vasorum in the development of vasculitis in animal model of Kawasaki disease

et al. 2014

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BackgroundKawasaki Disease (KD) involves a diffuse and systemic vasculitis of unknown etiology that mainly affects infants and children. Although a considerable number of analyses of the clinical, histopathological and molecular biological details underlying the mechanism responsible for the development of coronary arterial lesions, it is still poorly understood.The purpose of this study was to analyze the state of angiogenesis, vasculogenesis and the distribution of blood vessels using an animal model of KD like vasculitis. We investigated the involvement of the vasa vasorum from the adventitia in the vascular involvement and the development of the disease state by performing sequential histopathology, scanning electron microscopy (SEM) and micro computed tomography (CT) studies using a murine model of vasculitis induced by the Candida albicans water-soluble fraction (CAWS).MethodsTo prepare the animal model of KD like vasculitis, CAWS was intraperitoneally injected into C57BL/6N mice for five consecutive days as reported by Ohno et al. We observed the changes of the vasa vasorum at the aorta and the orifices of the coronary arteries by SEM and micro CT, and also compared the neovascularization at the media and adventitia of the aorta by an immunohistochemical analysis.ResultsAs previously reported, obvious inflammation was detected two weeks after the injection of CAWS, and also intimal thickening was observed three weeks after the injection. We found that the vasa vasorum in the adventitia of the aorta was increased in the model mice. The vasa vasorum started increasing one week after the injection of CAWS, before any obvious vasculitis was microscopically detected.ConclusionThe present results indicate that the vasculitis in Kawasaki disease starts as a disorder of the vasa vasorum.

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“…It is characterized by high fever, conjunctivitis, changes of the mucosae of the oropharynx and peripheral extremities, rash, and cervical lymphadenopathy [5]. The cardiac involvement determines the prognosis by the risk of myocarditis during the acute phase and the formation of coronary artery (CA) aneurysm during the subacute phase; the aneurysm may cause rupture or myocardial infarction [5,6]. The value of two-dimensional echocardiography and angiography for detecting CA aneurysms has been well documented [5,6,10,12].…”

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confidence: 99%

“…The cardiac involvement determines the prognosis by the risk of myocarditis during the acute phase and the formation of coronary artery (CA) aneurysm during the subacute phase; the aneurysm may cause rupture or myocardial infarction [5,6]. The value of two-dimensional echocardiography and angiography for detecting CA aneurysms has been well documented [5,6,10,12]. Intravascular ultrasound imaging (IVUS) offers more detailed information about the changes in the vessel wall [7].…”

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confidence: 99%

Intravascular Ultrasonography of an Adolescent Boy with a Coronary Artery Aneurysm Due to Kawasaki Disease

et al. 1997

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A 14-year-old boy developed coronary aneurysms during the course of Kawasaki disease. The vessel wall morphology of the coronary arteries was assessed by intravascular ultrasound imaging (IVUS). There was intimal thickening proximal to, within, and distal to a large coronary aneurysm in the left anterior descending coronary artery only 18 months after the acute onset of Kawasaki disease. Intimal thickening without calcification is a new IVUS finding within a persistent coronary aneurysm. It may indicate that the healing process, via cell proliferation is continuing, with the risk of causing a stenosis.

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Cardiac Involvement and Prognosis in Acute Mucocutaneous Lymph Node Syndrome

Cited by 61 publications

References 8 publications

A Swine Model of Horse Serum-Induced Coronary Vasculitis: An Implication for Kawasaki Disease

A Swine Model of Horse Serum-Induced Coronary Vasculitis: An Implication for Kawasaki Disease

The involvement of the vasa vasorum in the development of vasculitis in animal model of Kawasaki disease

Intravascular Ultrasonography of an Adolescent Boy with a Coronary Artery Aneurysm Due to Kawasaki Disease

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