Intravascular Ultrasonography of an Adolescent Boy with a Coronary Artery Aneurysm Due to Kawasaki Disease

Xylander, S. von; Mudra, Harald; Rieber, Johannes; Klaus, Volker; Döhlemann, C

doi:10.1007/s002469900224

Cited by 2 publications

(2 citation statements)

References 11 publications

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“…This difference may be due to a shorter interval after the onset of KD and continuous healing process of the vessel wall. Our finding is compatible with that by von Xylander et al (8) in terms of the presence of intimal thickening within a persistent aneurysm even a relatively short period of time after KD. Our case indicates that the healing process may continue via cell proliferation, with extension to the proximity of the coronary aneurysms.…”

Section: Discussionsupporting

confidence: 83%

Intravascular Ultrasound Findings of Coronary Wall Morphology in a Child with Kawasaki Disease

et al. 2001

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INTRODUCTIONKawasaki disease (KD) is an acute febrile vasculitis affecting primarily infants and young children, and 15% to 25% of affected children may subsequently develop coronary artery aneurysms, if not treated (1, 2). They may cause sudden death or ischemic heart disease as a result of thrombotic or stenotic occlusion of coronary arteries (3). Two-dimensional echocardiography and selective coronary angiography are standard methods to evaluate coronary artery lesions; however, these are limited to the assessment of wall morphology. Recent progress in intravascular ultrasound (IVUS) technology allows detailed visualization of morphological changes in vascular wall. However, only a limited number of studies have been reported on the coronary artery using IVUS imaging in patients with KD, and the intervals from the onset of the illness to the time of the IVUS study ranged from 7 to 16 yr (4-6).We illustrate IVUS findings of coronary wall morphology at 22 months after the onset of the disease in a girl with coronary aneurysms due to KD. CASE REPORTA 4-yr-old girl developed fever (39℃), reddening of the pharynx and a tender left-sided cervical adenopathy. She was tentatively diagnosed as having a streptococcal pharyngitis and oral cephalosporin was given at a primary care clinic, but her illness worsened with the appearance of erythematous swelling of both hands, arthralgia, myalgia, and abdominal pain. She was transferred to our hospital on 9th day of the disease.At admission, her general condition was poor and pyrexia (38.5℃), tachycardia (130/min), and arthralgia on both knees and ankles were noted. Bilateral conjunctival injections and oral involvement including strawberry tongue, mucosal hyperemia, and cracked and erythematous lips were evident. There was no cervical lymphadenopathy. Erythematous swelling of both hands and feet was also noted. There was a leukocytosis of 17,500/ L with 93% neutrophils, 6% lymphocytes and the platelet count was 236,000/ L. The erythrocyte sedimentation rate was increased to 132 mm/hr and the Creactive protein level, 30.5 mg/dL. Bacteriologic and serologic studies were negative. The electrocardiogram showed normal pattern. The initial echocardiogram showed aneurysms of the proximal right coronary artery with a maximum diameter of 9 mm, and dilatation of the mid-left anterior descending coronary artery with a diameter of 5 mm. The patient was immediately treated with intravenous gamma globulin (2 g/kg) and salicylate (100 mg/kg/day). The fever disappeared within 24 hr and all other clinical signs within a few days after the initiation of treatment.During follow-up, the patient had been treated with salicylate (5 mg/kg/day) and dipyridamole (4 mg/kg/day). Selective coronary angiography was performed to confirm the Intravascular ultrasound (IVUS) imaging was performed to assess the coronary wall morphology in detail at 22 months after the onset of Kawasaki disease in a girl who had developed coronary aneurysms at 4 yr of age. The sites of persistent aneurysms demonstrated a dila...

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Section: Discussionsupporting

confidence: 83%

Intravascular Ultrasound Findings of Coronary Wall Morphology in a Child with Kawasaki Disease

et al. 2001

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“…Another 18 cases were documented in other case reports. [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Among the 136 reported cases, including ours, the oldest patient was 17 years old, 27,32 suggesting that KD can affect patients of any age because adult-onset KD in patients from 18 to 68 years of age has also been previously identified. KD in adolescents is more likely to affect male patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of Kawasaki disease in adolescents

et al. 2021

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Objective Studies focusing on Kawasaki disease (KD) in adolescents are lacking in Southwest China. We systematically summarized the clinical characteristics of KD in adolescents to improve pediatricians’ recognition of this condition. Methods The clinical data of patients with adolescent-onset KD in our center were retrospectively analyzed. The patients were divided into Group A (n = 7), whose first hospitalization was at our hospital, and Group B (n = 10), who were transferred from their local hospital or community health center. Results Seventeen patients with adolescent-onset KD were identified (constituent ratio of 0.8%). Seven patients had an intermittent fever for >10 days. The incidence of incomplete KD was 52.9%. These patients had a high incidence of other atypical clinical manifestations. Fifteen patients were initially misdiagnosed with other infectious diseases. Although the incidence of typical KD was higher in Group B, the overall misdiagnosis rate at the initial stages was higher and the average fever duration on arrival and before IVIG administration were much longer in Group B than A. Conclusions KD in adolescents was frequently misdiagnosed, which might be associated with its atypical, diverse clinical features and pediatricians’ poor recognition. Pediatricians must be aware of the possibility of KD in adolescents.

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Intravascular Ultrasonography of an Adolescent Boy with a Coronary Artery Aneurysm Due to Kawasaki Disease

Cited by 2 publications

References 11 publications

Intravascular Ultrasound Findings of Coronary Wall Morphology in a Child with Kawasaki Disease

Intravascular Ultrasound Findings of Coronary Wall Morphology in a Child with Kawasaki Disease

Clinical characteristics of Kawasaki disease in adolescents

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