The patient continued to take Aspirin

The patient continued to take Aspirin (80mg/day), although she has expressed some resistance toward continuing this therapy as per the advice of her physicians.

Kawasaki disease is predominantly a disease of childhood, although cases have been reported in adults (Gomard-Mennesson et al., 2010; Wolff et al., 2007). It occurs primarily in the Asian population. The mean annual incidence is 90–112 per 100,000 people. In the United States the mean annual incidence is 6–9 per 100,000 children under 5 years of age, with a peak incidence in children between 1 and 2years of age (Gedalia, 2002; Rozo et al., 2004). The mean annual incidence in Britain and Australia is 3.6 and 3.7 per 100,000 people, respectively.
In the Arab Gulf countries(Oman, Bahrain and Saudi Arabia), cases of KD are infrequently reported, although the disease may be under diagnosed because of resemblance of the clinical signs and symptoms with other diseases (Al-Harbi, 2010; Al-Mosawi et al., 2006; Bhatnagar et al., 2003; Muzaffer and Al-Mayouf, 2002; Owa et al., 1995). In one retrospective study conducted in the Madinah region of Saudi Arabia, investigators reviewed all pediatric cases over a 3-year purchase MK-8669 in which a diagnosis of KD was suspected and in which the patient underwent cardiac evaluation. purchase MK-8669 Of 51 cases, only 24 patients were confirmed to have Kawasaki disease. Of the confirmed cases, most were of patients younger than 5 years of age, with a male to female ratio of 1.7:1 (Al-Harbi, 2010;Bhatnagar et al., 2003; Ghazal et al., 1998; Muzaffer and Al-Mayouf, 2002).
The likelihood of recurrence of Kawasaki disease increases with age. Recurrence within 2years of the initial onset of the disease is unusual. Multiple recurrences have been reported in rare cases having recurrences in adulthood (Parmar et al., 2003; Pemberton et al., 1999). A high index of suspicion is appropriate in patients with a confirmed history of Kawasaki disease who present with clinical signs consistent with the disease (Parmar et al., 2003; Pemberton et al., 1999).
Untreated disease usually resolves spontaneously after several weeks (Pemberton et al., 1999; Rozo et al., 2004) even though the major pathologic feature of KD is acute systemic vasculitis. Coronary artery lesions usually develop early in the acute phase, although they can infrequently develop more than 4weeks after the onset of the disease. These early lesions are characterized by endothelial cell edema, proliferation, necrosis, and adhesion of polymorphonuclear leukocytes to the endothelium (Cox and Sallis, 2009; Thabet et al., 2011). Because one of the classical criteria for Kawasaki disease is oral involvement, including lip erythema, dry cracked lips, and involvement of the oropharyngeal mucosa (Bhatnagar et al., 2003; Kanno et al., 2011),these signs may also be present in the setting of recurrent KD (Parmar et al., 2003).
The patient’s chief complaint when she was presented to the oral medicine clinic was lip swelling involving the cheek and eye lids on the ipsilateral side. She was on an antihistamine to exclude any allergic reaction to cats and foods, however, she did not respond to the medication. Also, histories of physical or surgical traumas causing any lip swellings were excluded as stated by the patient. No sign of any insect bite was observed since the swelling repeated almost on the same site with no response to antihistamine drugs. No relevance with any medical syndromes was observed which might indicate the involvement of any of the signs and symptoms e.g. Crohns’ Disease or Melkersson–Rosenthal Disease. Any other possible cause for lip swellings was investigated with no direct causative relevance emerged. All symptoms subsided spontaneously. She also experienced a single episode of laryngoedema which also resolved without treatment. Symptoms that the patient had experienced were not related to any environmental changes. The most recent laboratory results showed an ESR rate of 22mm/h. Some of the clinical signs and symptoms including lip involvement and the spontaneous resolution of the allergic-like reaction may suggest the possibility of a recurrence of KD in this case.