Is Kawasaki Disease a New Disease?

s Kawasaki disease (KD) a new disease? The article by Takahashi et al in this issue of the Journal may give us some suggestions.1 They reviewed 380 autopsy cases of pediatric systemic vasculitis syndrome from the last 50 years from the Annual of Pathological Autopsy Cases in Japan. The first diagnosed autopsy case of KD occurred in 1969. This was 2 years after Kawasaki’s first description of this disease in 1967.2 A small number of cases, however, were pathologically diagnosed as infantile polyarteritis or periarteritis nodosa before 1969. At the present time, infantile polyarteritis is thought to be identical to fatal KD pathologically,3 and now KD is known as a systemic vasculitis syndrome that occurs in infants and young children, with a wide spectrum of clinical symptoms and disease severity including fatal cases. In the old clinical literature before Kawasaki’s first description there are some case reports consistent with KD. Those clinical diagnoses consisted of polyarteritis nodosa,4 Stevens-Johnson syndrome5 and scarlet fever,6 which resemble KD in clinical presentation. In Japan, patients with prospectively suspected KD were seen after the 1950 s and they were diagnosed as having Izumi fever, Stevens-Johnson syndrome or scarlet fever.7 This means that KD certainly existed before Kawasaki’s first description. It is suspected, however, that those cases were very few in number and occurred seldom. Thus KD is not a new disease but newly recognized as a clinical entity by Dr Kawasaki’s piercing observation of the patients.