Questions in the Maternal and Child Health Forum have been answered by doctors from Henry Ford Health System.

Question Title: Link between Kawasaki and Leukemia?

Forum: The Maternal and Child Health Forum
Topic: Childhood Disease


My son was diagnosed by a Pediatric Cardiologist with Kawasaki Syndrome when he was 15 mons old. He received gamma globulin and was "instantly"
cured. He is now 4 yrs old. My son has bouts of constant nosebleeds and tested negative for leukemia approx 2 years ago. He also suffered from
high, unexplained fevers for an extended period of time after the
wasaki's. I recently met a woman whose son had leukemia and she said
I might want to have my son retested for the leukemia as it may just not
have shown up at the time of the first blood test. Other than the
nosebleeds and fevers (which he only gets occasionally now)he appears to
be healthy. Could there be a connection between the two? Am I being
paranoid?

Dear Michelle:

Kawasaki’s disease is most often diagnosed by a primary care physician. Since, you state your son was “cured” by the administration of gamma globulin, I trust that, even though a pediatric cardiologist made the diagnosis, the principal long-term risk of Kawasaki disease, coronary artery disease, no longer poses a threat to your son’s well-being.

Nose bleeds are frequent among young children. Leukemia would be an unusual explanation. Far more common would be irritation of the blood vessel-bearing nasal septum associated with insufficient humidity or the frequent colds normal children suffer. Occasionally, nose bleeds reflect a inherited disorder of coagulation such as von Willebrand’s disease. This can be sorted out by your pediatrician with help from a hematologist. Certain medications such as aspirin or ibuprofen can interfere with platelet function and exacerbate otherwise normal nose bleeds.

Transient fevers are common in normal preschool children. Usually such fevers accompany viral illnesses such as colds or less frequent bacterial infections such as strep throat. In other words, short-lived fevers associated with the frequent runny noses, coughs, and sore throats of childhood should not raise a concern about leukemia.

The presentation of leukemia is usually not subtle. Children with this condition almost always appear ill. Progressive loss of appetite, weight loss, loss of energy, lethargy, profound pallor, persistent severe bone pain, and prolonged unexplained fever are the kinds of symptoms which should trigger concerns about malignancy. In the case of your son, the fever following Kawasaki disease may well have reflected the inflammation of medium-sized arteries that are the hallmark of that disorder. Of course, there may have been other explanations. The most important point is that, according to your note, such prolonged fevers are a fact of your son’s past, not a plague of his recent or present life.

While we have learned a great deal about the origin of malignancies, much remains unknown, We now know about genes which promote and genes which suppress tumor development and tumor growth. Some individuals with chromosomal disorders are particularly prone to the development of malignancy. I trust your son does not have such a condition. The role of environmental influences on the development of leukemia is not yet clear. I have not come across any suggestion of a connection between Kawasaki disease and leukemia. We do not yet even know precisely what the cause of Kawasaki disease is. We have much to learn about both conditions.

It is not easy for a mother or father of a child who has suffered a serious condition such as Kawasaki disease to face the future, even if recovery seems evident. I hope my response helps a little. I encourage you to sit down with your pediatrician to review these matters.

This information is offered for educational purposes only. Your child’s physician has the ultimate responsibility to work with you to maximize your son’s health and well-being.




 

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