Kawasaki disease, Mycoplasma pneumoniae infection and anaplastic large cell lymphoma: An uncommon association

Jalel Chemli, Saida Hassayoun, Soumaya Ketata, Ajmi Houda, Moncef Mokni, Noura Zouari, Saoussen Abroug, Abdelaziz Harbi

Department of Cytopathology, Farhat Hached Hospital, Sousse, Tunisia.
Department of Paediatrics, Sahloul Hospital, Sousse, Tunisia.
Laboratory of Bacteriology-Virology, Sahloul Hospital, Sousse, Tunisia.

DOI: 10.4236/ojped.2012.23039                

Abstract

Kawasaki disease (KD) is an acute febrile systemic vasculitis occurring predominantly in young children less than 5 years of age. Although imperfectly known, the aetiopathogenesis of KD would be secondary to immunological abnormalities that could constitute a favourable terrain for neoplasms. We report on a case in a 2-year-old girl who presented clinical manifestations compatible with Kawasaki disease complicated by coronary aneurysm. Aetiopathological investigations revealed M. pneumoniae infection as specific IgM were present in the serum (Elisa). The patient was initially treated by intravenous immunoglobulins (IVIG) and aspirin to anti-inflammatory dose. Following a few days of desquamation, resolution of the symptomatology occurred. Four weeks later she developed disseminated tumorous syndrome. Lymph node biopsy revealed massive infiltration by large cells lymphomatous proliferation. Histologic and immunophenotypic findings were characteristic of ALK-1+ anaplastic large cell lymphoma. Four weeks later, the patient died from a severe nosocomial infection complicated by septic shock. Our observation is the first cases describing the association between anaplastic large cell lymphoma, KD and M. pneumoniae. Immunologic disorder due to KD and M. pneumoniae infection may play probably a central role for malignancy.

Keywords

Kawasaki Disease; Mycoplasma pneumoniae; Anaplastic Large Cell Lymphoma; Immunological Abnormality

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Kawasaki, T. (1967) Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of fingers and toes in children: Clinical observation of 50 cases. Japanese Journal of Allergology, 16, 178-222.
[2]	Murray, J.C., Bomgaars, L.R., Carcamo, B. and Mahoney, D.H. Jr. (1995) Lymphoid malignancies following Kawasaki disease. American Journal of Hematology, 50, 299-300. doi:10.1002/ajh.2830500414
[3]	Nakamura, Y., Yanagawa, H., Harada, K., Kato, H. and Kawasaki, T. (2002) Mortality among 139 persons with a history of Kawasaki disease in Japan. The fifth look. Archives of Pediatrics & Adolescent Medicine, 156, 162-165.
[4]	Suzuki, H., Takeuchi, T., Minami, T., Shima, Y., Iwahashi, S., Shibuta, S., Uemura, S., Kounami, S., Aoyagi, N. and Yoshikawa, N. (2005) Neoplasms in three patients following Kawasaki disease. Pediatrics International, 47, 217-219.
[5]	Chemli, J., Hassayoun, S., Ketata, S., Ajmi, H., Ayeche, H., Zouari, N., Abroug, S., Boujaafar, N. and Harbi, A. (2010) Kawasaki disease and Mycoplasma pneumoniae infection. Medecine et Maladies Infectieuses, 40, 717-719.
[6]	Merlin, E., Al Fatuhi, H. and Crost, P. (2004) Kawasaki syndrome and Mycoplasma pneumoniae infection. Archives of Pediatrics & Adolescent Medicine, 11, 972-979.
[7]	Vitale, E.A., La Torre, F., Calcagno, G., Infricciori, G., Fede, C., Conti, G., Chimenz, R. and Falcini, F. (2010) Mycoplasma pneumoniae: A possible trigger of Kawasaki disease or a mere coincidental association? Report of the first four Italian cases. Minerva Pediatrica, 62, 605-607.
[8]	Wang, J.N., Wang, S.M., Liu, C.C. and Wu, J.M. (2001) Mycoplasma pneumoniae infection associated with Kawasaki disease. Acta Paediatrica, 90, 594-595. doi:10.1111/j.1651-2227.2001.tb00810.x
[9]	Lee, M.N., Cha, J.H., Ahn, H.M., Yoo, J.H., Kim, H.S., Sohn, S. and Hong, Y.M. (2011) Mycoplasma pneumoniae infection in patients with Kawasaki disease. Korean Journal of Pediatrics, 54, 123-127.
[10]	Newburger, J.W., Takahashi, M., Gerber, M.A., Gewitz, M.H., Tani, L.Y., Burns, J.C., et al. (2004) Diagnosis, treatment, and long-term management of Kawasaki disease: A statement 158 for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, council on cardiovascular disease in the young, American Heart Association. Circulation, 110, 2747-2771. doi:10.1161/01.CIR.0000145143.19711.78
[11]	Inaba, H., Kawasaki, H., Nakamura, S., Yamamoto, H., Kaneko, Y., Satake, N., Komada, Y., Ito, M. and Sakurai, M. (1998) Anaplastic large cell lymphoma associated with Sj?gren’s syndrome. Leukemia and Lymphoma, 32, 183-188.
[12]	Nagata, S., Yamashiro, Y., Maeda, M., Ohtsuka, Y. and Yabuta, K. (1993) Immunohistochemical studies on small intestinal mucosa in Kawasaki disease. Pediatric Research, 33, 557-563. doi:10.1203/00006450-199306000-00004
[13]	Brogan, P.A., Shah, V., Clarke, L.A., Dillon, M.J. and Klein, N. (2008) T cell activation profiles in Kawasaki syndrome. Clinical & Experimental Immunology, 151, 267-274. doi:10.1111/j.1365-2249.2007.03567.x
[14]	Igarashi, H., Hatake, K., Tomizuka, H., Yamada, M., Gunji, Y. and Momoi, M.Y. (1999) High serum levels of M-CSF and G-CSF in Kawasaki disease. British Journal of Haematology, 105, 613-615. doi:10.1046/j.1365-2141.1999.01381.x
[15]	Terai, M., Yasukawa, K., Narumoto, S., Tateno, S., Oana, S. and Kohno, Y. (1999) Vascular endothelial growth factor in acute Kawasaki disease. American Journal of Cardiology, 83, 337-339. doi:10.1016/S0002-9149(98)00864-9
[16]	Coussens, L.M. and Werb, Z. (2002) Inflammation and cancer. Nature, 420, 860-867. doi:10.1038/nature01322
[17]	Mizukane, R., Kadota, J., Yamaguchi, T., Kiya, T., Fukushima, H., Nakatomi, M. and Kohno, S. (2002) An elderly patients with hemophagocytic syndrome due to severe Mycoplasma pneumonia with marked hypercytokinemia. Respiration, 69, 87-91. doi:10.1159/000049377