Produção Nacional
Revisado por pares
Yellow Fever Vaccination and Kawasaki Disease
2009; Lippincott Williams & Wilkins; Volume: 28; Issue: 11 Linguagem: Inglês
10.1097/inf.0b013e3181bbc571
ISSN1532-0987
AutoresDeonilson Ghizoni Schmoeller, Mauro Waldemar Keiserman, Henrique Luiz Staub, Flávio Petersen Velho, Marily de Fátima Grohe,
Tópico(s)Bacterial Infections and Vaccines
ResumoTo the Editors: Kawasaki Disease (KD) is nowadays the main cause of acquired heart disease among children in North America and Japan.1 The role of vaccination as a trigger for KD is enigmatic. We herein describe an unusual case of KD following yellow fever vaccination. The patient, a 12-year-old white boy living in a risk area for yellow fever, developed fever, fatigue, myalgia, and a diffuse rash, 20 days after yellow fever vaccination. After 2 weeks, the patient remained feverish. Conjuntivitis and cervical lymph node enlargement developed. Leukocytosis (17,000 cells/mm3), eosinophilia (1500 cells/mm3), and moderate anemia were present. The erythrocyte sedimentation rate was 112 mm in the first hour. Antinuclear antibodies and rheumatoid factors were absent. Tests for viral infections (cytomegalovirus, Epstein-Barr) and toxoplasmosis were negative. The echocardiogram revealed right (5 mm) and left (3.5 mm) dilated coronary lesions. KD was diagnosed, and the patient was treated with a 2 g/kg single dose of intravenous immunoglobulin plus acetyl-salicylic acid. After a week, he complained of intense arthralgia of the right knee and hip. Conjuntivitis reappeared. Low-dose prednisone (10mg daily) was started, with prompt clearing of the articular and ocular symptoms. One month later, a new echocardiogram showed partial improvement of coronary lesions (right coronary lumen 3.5 mm, left coronary lumen 2.8 mm). The current echocardiogram is normal. The patient has been asymptomatic on low-dose acetyl-salicylic acid. KD is an autoimmune systemic disorder, and the immune response to previous vaccination is a matter of interest in patients with established KD. Reactions at a Bacillus Calmette-Guerin vaccination scar site during the course of KD have been reported by 3 groups of authors.2–4 Of note, KD was reported in a 35-day-old infant following immunization with hepatitis B vaccine.5 Eleven cases of KD following rotavirus vaccine (Rota Teq) were recently identified.6 To our knowledge, no cases of KD following yellow fever vaccination have been reported so far. The attenuated live virus vaccine for yellow fever has been available since 1937.7 Adverse viscerotropic and neurotropic events are very rare following immunization with yellow fever vaccine.8 Our patient was 12 years old, an unusual age for KD9; thus, an exogenous trigger such as vaccine might have contributed to KD occurrence by an immunocomplex mechanism. Although no cause-and-effect association between receiving a vaccine and the occurrence of KD is assumed, the issue is polemic. In our patient, KD appearance after yellow fever vaccination could have been only coincidental. Nevertheless, the possibility of triggering of KD by vaccines should not be neglected. Deonilson Schmöeller, MD Mauro W. Keiserman, MD Henrique Luiz Staub, MSc, PhD Rheumatology Department Flávio Petersen Velho, MD Cardiology Department Marily de Fátima Grohe, MD Pediatrics Department São Lucas Hospital Pontifical Catholic University of Rio Grande do Sul (PUCRS) Porto Alegre, Brazil
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