Unfortunately, diagnosis within 10 days since the disease onset is set only in very few cases [6,8,13,36,45,49,52], whereas treatment is usually given late in others [2,15,37,44,50,51,55-57]. month later. Conclusions This statement of an adult case of European Kawasaki disease may be of benefit to physicians of various specialties, including main care doctors, hospital internists, intensivists and cardiologists. It demonstrates that a case of prolonged fever, unresponsive to antibiotics, in the absence of other diagnoses may be an incident of Kawasaki disease. It is worth stressing that such a diagnosis should be considered, even if the patient is adult and not of Asian lineage. cell wall extract . A genetic predisposition hypothesis is supported by: i) noticeable differences in incidence rates among people of various ethnic groups along with ii) a higher incidence of KD among siblings of a patient compared to the general population. Nevertheless, the genetic background of KD remains mostly unclear. A series of polymorphisms in a number of genes have been linked with increased susceptibility for KD, with the most notable ones being in  and . Finally, the genetic loci of and have also been suggested as susceptibility candidates by means of genome-wide association studies [21-23]. Diagnosis and complications KD diagnosis is absolutely clinical since no specific diagnostic Quinapril hydrochloride tests are available , although the proteins meprin A and filamin C were recently shown to possess potential as KD biomarkers . The diagnosis is possible if an individual has persistent fever for more than 5 days, is unresponsive to broad-spectrum antibiotics, has Rabbit Polyclonal to TRIM24 no proof of infection and four out of the five following criteria: i) polymorphous rash; ii) conjunctivitis; iii) cervical lymphadenopathy; iv) oral changes including injected pharynx or lips, cracked or fissured lips, strawberry tongue; v) extremity changes starting with oedema or erythema and then progressing to desquamation of feet and hands, starting periungually [1,2,12,15]. Unfortunately, these diagnostic criteria are valid for the diagnosis of KD in children, but have not yet been validated in adults . Coronary artery damage is the main and sometimes fatal complication of the disease, being expressed as aneurysm, calcification or stenosis [25,26]. Coronary artery aneurysms (CAA) can change with time: they may regress, stay unchanged, progress to obstruction and, rarely, rupture or expand . If coronary abnormalities are present, the diagnosis of KD can be Quinapril hydrochloride set even when less than four of the aforementioned criteria are met [5,27]. Susceptibility to coronary artery lesions formation has been associated in various populations with specific single nucleotide polymorphisms in a wide range of genes, such as , , ,  and . Arteries other than the coronary ones are also affected by the disease: a hepatic artery aneurysm , a left humeral artery aneurysm, with absence of flow in the antebrachial arteries causing a peripheral gangrene , a proximal gastroduodenal artery occlusion, and a mildly irregular splenic artery Quinapril hydrochloride associated with obstruction of the distal intrasplenic branches  are described in the literature. Systemic inflammation of many organs can occur. Inflammation of the central nervous system would cause typical meningitis  or just headache [2,8,32,36-43]. As to the myocardium and pericardium, KD may be the cause of tricuspid regurgitation with vegetations , mitral valve regurgitation with thickened mitral leaflets , pericardial effusion , myocarditis [12,36] or heart failure [12,46,47]. Clinical and laboratory findings concerning liver inflammation are jaundice [32,40,48,49], hepatomegaly [15,32,50], right upper quadrant pain [32,39], cholestatic hepatitis [6,44,46-49,51], hepatic artery aneurysm , elevated aspartate and alanine aminotransferase levels [2,8,11,13,33,34,40,41,43,52,53] and low albumin levels [11,40,53]. Mild renal failure, dysuria , as well as sterile leucocytosis in urine analysis [11,15] Quinapril hydrochloride can be manifestations of renal involvement in KD. The upper and lower respiratory system may also be affected. Reddened pharynx [35,38-43,47-49,54], sore throat [2,36,39,41,43,44,51,55-58], rhinorrhoea , mild nonproductive cough [39,43,44], dyspnoea , laboured respirations [32,48], rales , and.