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CASE IMAGE
Year : 2021  |  Volume : 1  |  Issue : 2  |  Page : 133-134

Alopecia areata during the convalescent phase of kawasaki disease


Department of Pediatrics, Advanced Pediatrics Centre, PGIMER, Chandigarh, India

Date of Submission01-Mar-2021
Date of Decision12-May-2021
Date of Acceptance14-May-2021
Date of Web Publication31-May-2021

Correspondence Address:
Dr. Ankur Kumar Jindal
Department of Pediatrics, Advanced Pediatrics Centre, PGIMER, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ipcares.ipcares_69_21

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How to cite this article:
Patra PK, Jindal AK. Alopecia areata during the convalescent phase of kawasaki disease. Indian Pediatr Case Rep 2021;1:133-4

How to cite this URL:
Patra PK, Jindal AK. Alopecia areata during the convalescent phase of kawasaki disease. Indian Pediatr Case Rep [serial online] 2021 [cited 2021 Jun 19];1:133-4. Available from: http://www.ipcares.org/text.asp?2021/1/2/133/317365

A 4-year-old boy presented with high-grade fever for a week and generalized rash for 5 days. Examination revealed cheilitis, a “strawberry” tongue, nonpitting edema over the dorsum of both hands, left anterior cervical lymphadenopathy, and an erythematous maculopapular rash on the trunk. There was no conjunctival injection. The child had anemia (hemoglobin: 8.9 g/L), leukocytosis (total leukocyte count: 27,000/L), thrombocytosis (850,000/L), and elevated values of erythrocyte sedimentation rate (60 mm in the 1st h), C-reactive protein (112 mg/dL), and pro B-type natriuretic peptide (5249 ng/ml, normal <194 ng/mL). Normal coronary artery Z-scores were reported on two-dimensional echocardiography. A diagnosis of Kawasaki disease (KD) was kept as four out of five diagnostic criteria were met. The child was started on intravenous immunoglobulin and aspirin as per protocol. He became afebrile within 24 h and was discharged on low-dose oral aspirin (3 mg/kg/day) on day 4. He presented at 4 weeks with patchy loss of hair since a few days. There was no history of self-mutilation. The nonscarring occipital scalp lesion was typical of alopecia areata [Figure 1]a. Common causes (hypothyroidism, autoimmunity, and tinea capitis) were ruled out. Beau's lines were also noted [Figure 1]b. Both were considered secondary to KD. The alopecia resolved within 2 months and the Beaus lines disappeared as the nails grew out.
Figure 1: (a) Alopecia areata over occipital area in the index patient noted at 4 weeks after discharge. (b) Beau's line over the finger nails at 4 weeks of follow-up

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KD is a medium-vessel vasculitis affecting young children.[1] It has been reported with autoimmune disorders such as celiac disease, autoimmune hemolytic anemia, and others. KD-associated alopecia has been reported in children previously: a 26-month-old boy with diffuse hair loss[2] and a 10-year-old boy with alopecia areata.[3] In both cases, the alopecia resolved with recovery from KD. Diffuse hair loss is often seen during acute stress or illnesses. This results in a large proportion of hair follicles rapidly converting from the anagen phase to the telogen phase (telogen effluvium) resulting in hair loss. This is often seen with the appearance of Beau's lines, which are nonspecific transverse grooves that develop within the nail plate. These may be due to a transient arrest of or dystrophic production of the nail matrix due to interference with the blood supply. High-grade fever and a variety of systemic, infectious (including KD) cutaneous disorders and medication may result in these.

The pathogenesis in alopecia areata is more specific and autoimmune related. Affected follicles are infiltrated with T-lymphocytes with resultant release of cytokines. Alopecia areata has often been reported concurrently with Hashimoto's thyroiditis and other autoimmune disorders. The role of monocyte chemoattractant protein-1 (MCP-1) has been implicated in KD. Not only does it regulate the recruitment of monocytes around hair follicles,[4] but also it is associated with the pathogenesis of coronary artery abnormalities in KD[5] due to polymorphisms found in the regulatory region of MCP-1 gene. Thus, alopecia areata, an innocuous finding in itself, can be helpful in understanding and exploring the underlying autoimmune etiopathogenesis of KD.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the guardian has given consent for images and other clinical information to be reported in the journal. The guardian understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Singh S, Kawasaki T. Kawasaki disease – An Indian perspective. Indian Pediatr 2009;46:563-71.  Back to cited text no. 1
    
2.
Nabavizadeh SH, Safari M, Amin R. Hair loss as a sign of Kawasaki disease. Iran J Allergy Asthma Immunol 2006;5:199-200.  Back to cited text no. 2
    
3.
Krishnamurthy S, Chandrashekar L, Mondal N. Kawasaki disease and alopecia areata: Coincidence or a true association? Pediatr Dermatol 2012;29:532-4.  Back to cited text no. 3
    
4.
Benoit S, Toksoy A, Goebeler M, et al. Selective expression of chemokine monokine induced by interferon-gamma in alopecia areata. J Invest Dermatol 2003;121:933-5.  Back to cited text no. 4
    
5.
Jibiki T, Terai M, Shima M, et al. Monocyte chemoattractant protein 1 gene regulatory region polymorphism and serum levels of monocyte chemoattractant protein 1 in Japanese patients with Kawasaki disease. Arthritis Rheum 2001;44:2211-2.  Back to cited text no. 5
    


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