Enlarged bronchial arteries are associated in some patients with transposition of the great arteries and intact ventricular septum. The etiology of these enlarged bronchial arteries is not yet known. In this report, we describe a case of TGA/IVS in which enlarged bronchial arteries were demonstrated from the prenatal period. The arteriogram at one year after arterial switch repair demonstrated enlarged bronchial arteries. This prenatal information may be useful for deciding on a strategy for postnatal treatment and counseling the family members.
Yersinia pseudotuberculosis (Y. pseudotuberculosis) infection complicated with bacteremia rarely occurs. Y. pseudotuberculosis infection is also known to produce various symptoms similar to Kawasaki disease (KD) due to the production of Y. pseudotuberculosis-derived mitogen (YPM), an exotoxin with superantigen activity. Moreover, it causes terminal ileitis and is responsible for appendix swelling. Here, we report a case of Y. pseudotuberculosis infection in a 10-month-old boy who was brought to our hospital due to fever, watery stool, and poor vitality. Abdominal echocardiography revealed wall thickening of the entire colon and appendix swelling; therefore, he was admitted and treated with antibiotics for bacterial enteritis or appendicitis. After the antibiotic administration, facial skin rashes and hand and foot edema developed. However, he had 5/6 major symptoms of KD and was diagnosed with Y. pseudotuberculosis infection because of its presence in the blood and stool cultures. Thereafter, antibacterial therapy improved his symptoms and increased the inflammatory response. After his hospital discharge, the skin on his fingers showed desquamation like that of KD. Y. pseudotuberculosis infection should be considered as a differential disease in KD, terminal ileitis, and appendicitis. Furthermore, its infection route and culture methods should also be carefully considered.
We report two cases of coronary aneurysms that were not previously diagnosed during acute illness but were discovered for the first time during school cardiac screening (SCS). Case 1 was a 6-year-old boy who had successful immunoglobulin treatment for typical Kawasaki disease (KD) at the age of 3. Though an echocardiographic examination during acute phase was reported as normal, echocardiography at SCS demonstrated giant left coronary aneurysms separated by coronary artery stenosis. Consequently, the patient was placed on oral warfarin and underwent percutaneous coronary angioplasty and coronary artery bypass surgery. Case 2 was a 13-year-old boy who had a 9-day history of fever with several signs of KD and had been receiving treatment for juvenile idiopathic arthritis at 9 years of age. Though an echocardiographic examination at 9 day of the illness was reported as normal, echocardiography at SCS demonstrated a moderate sized left coronary artery aneurysm that was thought to be a sequela of incomplete KD. Consequently, the patient was administered oral aspirin and was regularly followed-up. These cases illustrates that SCS may present an important opportunity to diagnose coronary aneurysm in patients with a history of complete or incomplete KD. As the presence of coronary aneurysms significantly alters treatment and prognosis, guidelines for echocardiography quality control and the proper timing of echocardiography in patients with incomplete KD are required.
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