AUTOIMMUNE HEMOLYTIC-ANEMIA AFTER KAWASAKI-DISEASE IN A CHILD

A 2-year-old male presented with upper respiratory tract infection sym ptoms, continuous high fever, extensive truncal rash with desquamation , lymphadenopathy, subconjunctival hemorrhage, and oral stomatitis. He was diagnosed with Kawasaki disease and did well on aspirin. Approxim ately 8 weeks after initial presentation he had evidence of severe imm une hemolysis. At that time a direct antiglobulin test was microscopic ally positive; it became strongly positive (3 + IgG, w + C3) 2 weeks l ater. The serology was unusual in that a warm IgG autoantibody and a l ow titer high thermal range cold antibody of unusual specificity (anti -En(a) or anti-Pr) were present. We were uncertain as to which antibod y caused the hemolysis, or whether they worked synergistically. The he molysis resolved following treatment with high dose prednisone.