Walsh & Hoyt: Pathology

Kawasaki disease is characterized pathologically by severe inflammation and vasculitis that affect primarily small and medium-sized musculoelastic arteries. The most impressive pathologic changes are found in the heart, but similar changes occur in arteries of the brain, adrenal glands, gastrointestinal tract, kidneys, lungs, mesentery, pancreas, spleen, and testes. Biopsy of skin lesions in Kawasaki patients show dilation of small blood vessels, extensive edema, and an infiltrate of lymphocytes and macrophages. The inflammatory infiltrate contains activated (CD4+) helper/inducer T-lymphocytes and activated (CD13+) macrophages. In addition, affected tissues show increased concentrations of both interleukin-1 and tumor necrosis factor alpha (TNF-alpha).