Copyright© 2006, IRANIAN JOURNAL OF ALLERGY, ASTHMA AND IMMUNOLOGY. All rights reserved. 199
Iran J Allergy Asthma Immunol
December 2006; 5(4): 199-200
Hair Loss as a Sign of Kawasaki Disease
Sayyed Hesamedin Nabavizadeh, Mojgan Safari, and Reza Amin
Department of Allergy and Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Received: 14 September 2005; Received in revised form: 2 March 2006; Accepted: 4 April 2006
Kawasaki disease is a multi system disorder with varying clinical expressions. This disease
is an acute systemic vasculitis of unknown etiology that has recently recognized as a leading
cause of acquired heart disease in children of many developed countries. We describe an
unusual instance of hair loss in a patient with Kawasaki disease.
A 26 months old boy developed prolonged high fever, bilateral conjunctival infection,
arthralgia and erythromatosis skin rash. He was admitted to the hospital with the diagnosis of
Kawasaki disease. Laboratory results included an erythrocyte sedimentation rate (ESR) above
100 and platelet count > 1000,000. The patient developed acute and unprovoked scalp hair
loss. He was treated with intravenous immunoglobulin (IVIG) 2 g/kg and aspirin 100
mg/kg/day with complete improvement of signs and symptoms.
This report documents hair loss as an uncommon presentation of Kawasaki disease.
Key words: Acute vasculitis; Fever; Hair loss; Kawasaki
Kawasaki disease (KD) is a systemic vasculitis of
childhood with a predilection for the coronary arteries.
It is the predominant cause of pediatric acquired heart
disease in developed countries. The aetiology of KD
remains unknown.1 The disease can present with
protean clinical manifestations which include high
grade fever (for at least 5 days), rash, redness of the
lips and a typical strawberry tongue, cervical lymph
node enlargement (often unilateral), swelling over the
hands/feet and, later a characteristic peripheral
desquamation over the fingers and toes. These clinical
features appear sequentially and the findings may
change from day-to-day.2
Corresponding Author: Sayyed Hesamedin Nabavizadeh, MD;
Department of Allergy and Immunology, Pediatric Ward-Namazee
Hospital, School of Medicine, Shiraz University of Medical Sciences,
Shiraz, Iran. Tel: (+98 741) 3336 577, Fax: (+98 711) 6265 024
Other manifestations may include diarrhea,
vomiting, abdominal pain, hydropse of gallbladder,
myositis, ulcerative stomatitis, aseptic meningitis,
cranial or peripheral nerve palsies, transient arthritis
Cardiac involvement is the most important
manifestation of Kawasaki disease.2 We describe a case
of diffuse hair loss in a 26 month old boy with KD.
A 26 months old well-nurished boy from town of
Yasuj without any significant past history developed
high and constant fever, irritability and body pain since
12 days prior to admission and was treated with
antibiotic and antipyretic without any response. 2-3
days later. He developed a confluent, erythrematosis,
papular rash over the face, trunk and extremities.
His lips became red and swollen. Bilateral
nonsupporative conjunctival injection was also noted.
S.H. Nabavizadeh, et al.
200/ IRANIAN JOURNAL OF ALLERGY, ASTHMA AND IMMUNOLOGY Vol. 5, No. 4, December 2006
sedimentation rate (ESR) of 70mm/h, which increased to
108 mm/h and white blood cell count of 15900 that
increased to 22500/mm. Platelet count was 750,000
initially and increased to 1100,000/mm (in the course of
hospital and after treatment with IVIG). Blood, throat,
stool and urine cultures
abnormalities. KD was diagnosed based on the presence
of prolonged fever and four main diagnostic criteria.
developed non tender sub mandibular
data included an erythrocyte
Figure 1. Hair loss in a patient with Kawasaki disease.
The patient developed acute and diffuse scalp hair
loss on admission and on the 6th day of fever. Hair loss
was generalized and progressive with approximately
40-50 hairs loss in one hour (Figure 1).
He was treated with intravenous immunoglobulin
(IVIG) 2 g/kg and aspirin 100 mg/kg with improvement
of signs and symptoms. The hair loss stopped
completely 12 hours after IVIG.
KD is the second most common vasculitic disorder
of children. KD causes a severe vasculitis of all blood
vessels but predominantly affects medium sized artery
with predilection for coronary arteries.2
In the most severely affected vessels, inflammation
involves all three layers of vascular wall with
destruction of the internal elastic lamina. Thrombi may
form in the lumen and obstruct blood flow.3 Vasculiltis
in KD may rise to multisystem vasculitis syndrome e.g:
ocular cellutites,4 smooth
consiousness disorder6 and facial nerve paralysis.7
The diffuse loss of hair can occur following high
fever, severe illness or stress. Because in this condition
all the follicles of hairs from anagen phase enter
telogen and these hair are therefore shed, but this
condition is commonly seen 4-9 months after stress .8
This rare condition may be attributed to vasculitis,
stress or heightened inflammatory response. KD with
involvement of vasculature of different organs can
produce different signs and symptoms. Therefore with
presence of principle criteria of KD, this uncommon
presentation should not make the physician confused.
1. Royle j, Burgner D, Curtis N. The diagnosis and
management of Kawasaki disease. J Paediatr Child Health
2. Singh S, Kansra S. Kawasaki disease Natl Med J India
3. Muzaffer MA, Al-Mayouf SM. Pattern of clinical features
of Kawasaki disease. Saudi Med J 2002; 23(4):409-12.
4. Bachmeyer C, Turc Y, Curan D, Duval-Arnould M Anterior
uveitis as the initial sign of adult Kawasaki syndrome
(mucocutaneous lymph node syndrome). Am J Ophthalmol
2000; 129 (1):101-2.
5. Wurzburger BJ, Avner JR: Lateral rectus palsy in Kawasaki
disease. pediatr. Infect Dis J 1999: 18(11):1029-31.
6. King WJ, Schlieper A, Birdi N, Cappelli M, Korneluk Y,
Rowe PC. The effect of Kawasaki disease on cognition and
behavior. Arch Pediatr Adolesc Med 2000; 154(5):463-8.
7. Larralde M, Santos-Munoz A, Rutiman. Kawasaki disease with
facial nerve paralysis Pediatr Dermatol 2003; 20(6):511-3.
8. Mackie R. Clinical Dermatology. Oxford: Oxford
University Press, 1997: 215.