Coronary artery aneurysms that occur in 25% of untreated Kawasaki disease (KD) patients may remain clinically silent for decades and then thrombose resulting in myocardial infarction. Although KD is now the most common cause of acquired heart disease in children in Asia, the United States, and Western Europe, the incidence of KD in Egypt is unknown. We tested the hypothesis that young adults in Egypt presenting with acute myocardial ischemia may have coronary artery lesions due Kawasaki disease (KD) in childhood. We reviewed a total of 580 angiograms of patients ≤ 40 years of age presenting with symptoms of myocardial ischemia. Coronary artery aneurysms were noted in 46 patients (7.9 %) of whom nine presented with myocardial infarction. The likelihood of antecedent KD as the cause of the aneurysms was classified as definite (n=10), probable (n=29), or equivocal (n=7). Compared to the definite and probable groups, the equivocal group had more traditional cardiovascular risk factors, smaller sized aneurysms, and fewer coronary arteries affected. In conclusion, in a major metropolitan center in Egypt, 6.7% of adults age 40 years or younger undergoing angiography for evaluation of possible myocardial ischemia had lesions consistent with antecedent KD. Because of the unique therapeutic challenges associated with these lesions, adult cardiologists should be aware that coronary artery aneurysms in young adults may be due to missed KD in childhood.

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[first paragraph of article]Kawasaki disease (KD) is a serious vasculitis of children first described by Tomisaku Kawasaki five decades ago. Its etiology is unknown, which led to the miasma (bad air) theory of disease as a possible explanation; this theory of disease was accepted in ancient times pointing to the existence of microorganisms unseen by human eyes as the cause for many disease of unknown etiology. So investigators started to look for airborne pathogens which could be the culprit for causing KD.

[first paragraph of article]Coronary artery aneurysm (CAA) is found in 0.3–5% of patients undergoing coronary angiography. Atherosclerosis is the main cause, followed by Kawasaki disease and infectious emboli. The pathogenetic mechanisms underlying aneurysm formation have not been clearly delineated, but inflammation is suspected to play a role. Symptoms, if present, are usually related to myocardial ischemia. In adults, angiography is the mainstay for diagnosis. Management varies from antithrombotic therapy to PCI or surgical treatment.

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