Acute Kawasaki Disease With Concomitant Adenovirus Infection

Background Adenovirus infection is the most common condition in the differential diagnosis of acute Kawasaki disease (KD), but it may also occur as a concomitant infection, the relevance of which has been incompletely defined. Methods A prospectively maintained, single-center database of all presenting patients with acute KD was queried. Patients with laboratory evidence of adenovirus infection were compared to patients with no laboratory evidence of any concomitant infection of any type. We sought to determine differences in demographics, clinical and laboratory features, treatment received and coronary artery (CA) outcomes. Results From 1997-2023, 1442 patients who had no laboratory evidence of concomitant infection and 39 patients positive for adenovirus were compared. There were no differences regarding demographics and few differences regarding clinical features at presentation, with 72% in each group meeting guideline criteria for a diagnosis of complete KD. Patients positive for adenovirus were less likely to have rash (69% versus 88%; p<0.001), were more likely to have respiratory (61% versus 20%; p<0.001) and gastrointestinal symptoms (47% versus 27%; p=0.007), and had less severe laboratory abnormalities. Adenovirus positivity was not associated with an increased risk of resistance to intravenous immunoglobulin. CA involvement was not observed in any patient in the adenovirus group (p=0.049). Conclusions The presence of positive evidence of adenovirus in the setting of acute KD does not appear to confound the diagnosis of KD, the response to which should be prompt initiation of immunomodulatory treatment. CA outcomes appear to be excellent.