Coronary Microaneurysms—An Early Manifestation of Kawasaki Disease: A Case Report

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ABSTRACT

Introduction

Kawasaki disease (KD) is a medium-vessel vasculitis with a predilection for coronary arteries and has been recognized to be the most common cause of acquired heart disease in children (Hedrich et al., 2018; Newburger et al., 2016; Saguil et al., 2015; Singh et al., 2018; Sundel, 2015). Hedrich et al. (2018) outline how coronary artery aneurysms are a typical manifestation of KD that develops after several weeks of disease.

Case presentation

This case report describes the clinical course and outcomes of a patient, a 5-year-old Hispanic female with KD who displayed early development of coronary microaneurysms as opposed to the typical late sequelae development.

Discussion and conclusion

This unique presentation of KD highlights some crucial questions that should be addressed, including whether coronary artery aneurysms should be reconsidered as only a late sequela of untreated disease. Can coronary artery aneurysms be an early manifestation of KD?

How to cite this article

Godin SL. Coronary Microaneurysms—An Early Manifestation of Kawasaki Disease: A Case Report. Pediatr Inf Dis 2023;5(2):49-51.

Related collections

Most cited references 6

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Kawasaki Disease.

Jane W Newburger, Masato Takahashi, Jane C. Burns (2016)

Kawasaki disease is an acute, self-limited vasculitis of unknown etiology that occurs predominantly in infants and children. If not treated early with high-dose intravenous immunoglobulin, 1 in 5 children develop coronary artery aneurysms; this risk is reduced 5-fold if intravenous immunoglobulin is administered within 10 days of fever onset. Coronary artery aneurysms evolve dynamically over time, usually reaching a peak dimension by 6 weeks after illness onset. Almost all the morbidity and mortality occur in patients with giant aneurysms. Risk of myocardial infarction from coronary artery thrombosis is greatest in the first 2 years after illness onset. However, stenosis and occlusion progress over years. Indeed, Kawasaki disease is no longer a rare cause of acute coronary syndrome presenting in young adults. Both coronary artery bypass surgery and percutaneous intervention have been used to treat Kawasaki disease patients who develop myocardial ischemia as a consequence of coronary artery aneurysms and stenosis.

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Kawasaki Disease: an Update

Eileen Rife, Abraham Gedalia (2020)

Purpose of Review Provide the most recent updates on the epidemiology, pathogenesis, and treatment advances in Kawasaki disease. Recent Findings Treatment advances in complex, IVIG-refractory cases of Kawasaki disease. Multisystem inflammatory syndrome, a newly reported inflammatory condition with Kawasaki-like features and an association with the 2019 Coronavirus (COVID-19). Summary Kawasaki disease (KD) is a rare systemic inflammatory disease that predominately affects children less than 5 years of age. Pathogenesis of KD remains unknown; the leading theory is that an unknown stimulus triggers an immune-mediated inflammatory cascade in a genetically susceptible child. Classic KD is a clinical diagnosis based on set criteria and excluding other similar clinical entities. Patients who do not fulfill complete diagnostic criteria for KD are often referred to as atypical (or incomplete) KD. The most feared complication of KD is coronary artery abnormality development, and patients with atypical KD are also at risk. Administration of intravenous immunoglobulin (IVIG) and aspirin has greatly reduced the incidence of coronary lesions in affected children. Several other immune-modulating therapies have recently been utilized in complex or refractory cases.

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Diagnosis of Kawasaki disease

Surjit Singh, Ankur Kumar Jindal, Rakesh Kumar Pilania (2017)

Abstract Kawasaki disease (KD) is a medium vessel vasculitis with predilection for coronary arteries. Due to lack of a reliable confirmatory laboratory test, the diagnosis of KD is based on a constellation of clinical findings that appear in a typical temporal sequence. These diagnostic criteria have been modified from time to time and the most recent guidelines have been proposed by the American Heart Association (AHA) in 2017. However, several children may have incomplete or atypical forms of KD and the diagnosis can often be difficult, especially in infants and young children. In this review, we have detailed the steps involved in arriving at a diagnosis of KD and also highlight the important role of echocardiography in diagnosis and management of children with KD.

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Author and article information

Contributors

Shea-Lee Godin: URI : https://orcid.org/0000-0003-3227-368X

Journal

Journal ID (publisher-id): PID

Title: Pediatric Infectious Disease

Abbreviated Title: PID

Publisher: Jaypee Brothers Medical Publishers

ISSN (Electronic): 2582-4988

Publication date (Print): April-June 2023

Volume: 5

Issue: 2

Pages: 49-51

Affiliations

[1]South Texas Health System, Edinburg, Texas, United States

Author notes

Shea-Lee Godin, South Texas Health System, Edinburg, Texas, United States, Phone: (708) 916-6600, e-mail: sgodin@ 123456mail.sjsm.org

Article

DOI: 10.5005/jp-journals-10081-1377

SO-VID: bc34d96d-c0eb-4f12-b2ea-ccf2b7b772cc

License:

© The Author(s). 2023 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 27 May 2022

Date accepted : 16 October 2022

Date: 30 June 2023

Custom metadata

file-pdf pid-05-049.pdf

ScienceOpen disciplines: Pediatrics

Keywords: Kawasaki disease,Coronary artery aneurysm,Pediatric,Kawasaki

Data availability:

ScienceOpen disciplines: Pediatrics

Keywords: Kawasaki disease, Coronary artery aneurysm, Pediatric, Kawasaki

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