Freeman Alexandra F, Crawford Susan E, Finn Laura S, López-Andreu Juan A, Ferrando-Monleón Susana, Pérez-Tamarit Desamparados, Cornwall Mona L, Shulman Stanford T, Rowley Anne H
Department of Pediatrics, Feinberg School of Medicine, Chicago, Illinois, USA.
Pediatr Pulmonol. 2003 Aug;36(2):102-6. doi: 10.1002/ppul.10333.
Symptomatic pulmonary manifestations of Kawasaki disease (KD) are uncommon. However, epidemiologic, radiologic, and histologic studies have indicated that respiratory symptoms and findings occur in KD and suggest that the KD agent may have a respiratory portal of entry. We report on three young infants with KD who developed pulmonary nodules, in addition to coronary artery aneurysms. Two patients had pathologic specimens available, one from biopsy and the other from autopsy. The nodules had predominantly mononuclear cell infiltrates, which were within the lung parenchyma and infiltrating vessel walls. Immunohistochemical studies of the nodules, using antibodies to common leukocyte antigen (LCA) and factor VIII-related antigen, confirmed the inflammatory nature of the lesions and showed capillary proliferation. IgA plasma-cell infiltration was observed in the nodule, consistent with previous KD findings of IgA plasma-cell infiltration in the vessel walls, kidneys, pancreas, and upper respiratory tract. The two patients with nonfatal KD were treated with intravenous immunoglobulin and aspirin, with resolution of the nodules. We propose that when pulmonary involvement occurs in KD, it ranges from subclinical interstitial micronodular infiltrates to larger inflammatory pulmonary nodules. These pulmonary infiltrates and nodules likely reflect the host response to the etiologic agent of KD, and may resolve with the disease process. Recognition of this pulmonary complication of KD may enable cautious observation of such lesions for spontaneous resolution.
川崎病（KD）的症状性肺部表现并不常见。然而，流行病学、放射学和组织学研究表明，KD患者会出现呼吸道症状和体征，提示KD病原体可能经呼吸道进入人体。我们报告了3例患有KD的幼儿，除冠状动脉瘤外还出现了肺结节。两名患者有病理标本，一份来自活检，另一份来自尸检。这些结节主要有单核细胞浸润，位于肺实质内并浸润血管壁。使用抗共同白细胞抗原（LCA）和因子VIII相关抗原的抗体对结节进行免疫组织化学研究，证实了病变的炎症性质并显示有毛细血管增生。在结节中观察到IgA浆细胞浸润，这与之前在KD患者血管壁、肾脏、胰腺和上呼吸道中发现的IgA浆细胞浸润情况一致。两名非致命性KD患者接受了静脉注射免疫球蛋白和阿司匹林治疗，结节消退。我们认为，KD出现肺部受累时，范围从亚临床间质性微小结节浸润到较大的炎性肺结节。这些肺部浸润和结节可能反映了宿主对KD病原体的反应，并可能随疾病进程而消退。认识到KD的这种肺部并发症，可能有助于对这类病变进行谨慎观察，以使其自行消退。
