Autoimmune hemolytic anemia after Kawasaki disease in a child

A 2-year-old male presented with upper respiratory tract infection symptoms, continuous high fever, extensive truncal rash with desquamation, lymphadenopathy, subconjunctival hemorrhage, and oral stomatitis. He was diagnosed with Kawasaki disease and did well on aspirin. Approximately 8 weeks after initial presentation he had evidence of severe immune hemolysis. At that time a direct antiglobulin test was microscopically positive; it became strongly positive (3 + IgG, w + C3) 2 weeks later. The serology was unusual in that a warm IgG autoantibody and a low titer high thermal range cold antibody of unusual specificity (anti-Ena or anti-Pr) were present. We were uncertain as to which antibody caused the hemolysis, or whether they worked synergistically. The hemolysis resolved following treatment with high dose prednisone.