Histologic and Immunohistochemical Evaluation of Infiltrating Inflammatory Cells in Kawasaki Disease Arteritis Lesions

Abstract

Kawasaki disease (KD) is a systemic vasculitis of unknown etiology which predominantly affects medium- and small-sized muscular arteries. Histopathologic studies of KD vasculitis lesions have demonstrated characteristic T cell infiltration and an abundance of CD8+ T cells; however, the contribution of cytotoxic lymphocytes to KD vasculitis lesions has not been identified. Here, we histopathologically and immunohistochemically examined infiltrating inflammatory cells, particularly cytotoxic protein-positive cells, such as granzyme B+ cells and TIA-1+ cells, in KD vasculitis lesions. Three autopsy specimens with acute-phase KD were observed and contained 24 vasculitis lesions affecting medium-sized muscular arteries, excluding pulmonary arteries. Infiltrating neutrophils in vasculitis lesions were evaluated by hematoxylin and eosin staining, and monocytes/macrophages and lymphocytes were evaluated by immunohistochemistry. The predominant cells were CD163+ monocytes/macrophages and CD3+ T cells. CD8+ T cells, granzyme B+ cells, and TIA-1+ cells were also observed, but CD56+ natural killer cells were rare. To the best of our knowledge, the current study is the first histopathologic report confirming the infiltration of inflammatory cells with cytotoxic proteins in vasculitis lesions in patients with KD. Cytotoxic T cells may play a role in the development of vasculitis lesions in KD patients.

Histopathological Study of a Broad Spectrum of Skin Dermatoses in Patients Affected or Highly Suspected of Infection by COVID-19 in the Northern Part of Italy: Analysis of the Many Faces of the Viral-Induced Skin Diseases in Previous and New Reported Cases

“…There have been reports of a possible association of the COVID-19 infection with Kawasaki syndrome, a systemic vasculitis of unknown etiology that characteristically presents coat-sleeve–like perivascular infiltrate composed mainly of cytotoxic CD8+ lymphocytes. 7 …”

Phenotype, Susceptibility, Autoimmunity, and Immunotherapy Between Kawasaki Disease and Coronavirus Disease-19 Associated Multisystem Inflammatory Syndrome in Children

“…Micro-embolism and thrombosis indicating vasculitis and coagulopathy are similar between fatal patients with COVID-19 with ARDS and fatal patients with SARS (75,76). Pathological findings of autopsy in KD are vasculitis with leukocyte infiltration, called periarteritis nodosa-like arteritis, coronary thrombosis with macrophage and lymphocyte infiltration, and aneurysm, but not pulmonary vasculitis (42,77,78). Autopsy features in MIS-C have not been characterized yet.…”

Imaging Diagnostics and Pathology in SARS-CoV-2-Related Diseases

“…Differently, in children, a possible association between SARS-COV-2 infection and Kawasaki disease has been hypothesized [37,38]; similarly to what was observed by Gianotti et al [23], Kawasaki disease exhibits a characteristic perivascular infiltrate that is mainly composed of cytotoxic CD8 lymphocytes associated to hypereosinophilia [39]. Hypereosinophilia could play an important role in vascular thrombosis, as it has shown this role on the activation of the coagulation cascade [40].…”

“…Nevertheless, analyzing the most recent radiological data about SARS-CoV-2 pneumonia, it is clear that imaging features may be variable and patient-specific. Specifically, about 75% of subjects with bilateral lung [ 11 , 12 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ] and multilobe involvement were also common [ 56 ]. In a case series of 21 patients affected by SARS-CoV-2, ground-glass opacity was the main imaging feature detected by chest CT [ 57 ], and 29% of these displayed consolidation [ 56 ].…”