Table 1.

A challenge to widely held views about Kawasaki disease

Widely held view	What the data show
Findings in KD peripheral blood mirror events in   target tissue	Neutrophils and CD4 T lymphocytes predominate in peripheral blood in acute KD whereas   CD8 T lymphocytes, macrophages, eosinophils, and plasma cells predominate in target   tissues [22, 49, 50]
KD is an autoimmune disease	KD rarely recurs, is most common in young infants, autoantibodies are not more prevalent   in KD patients than controls [13], immune complexes are not observed in KD tissues, KD   synthetic antibodies target cytoplasmic inclusion bodies consistent with aggregates of viral   proteins and RNA [24, 25•]
Upregulation of cytokines in KD indicates the   presence of a superantigen	Cytokines are upregulated in virtually all systemic infectious and inflammatory diseases;   presence of a specific adaptive immune response in KD argues against a superantigen as   the cause for cytokine upregulation [15, 17]
KD results from “unusual immune response” to   many different etiologic agents	No precedent exists for an acute febrile systemic illness with distinctive clinical features to   be the result of multiple diverse etiologic agents. Polio, roseola, Fifth disease, and AIDS   were similarly proposed to represent an “unusual immune response to many different   etiologic agents” prior to identification of their causative agents, all of which were found   to be single viruses or a group of closely related viruses.

KD—Kawasaki disease.