Kawasaki disease: involution of giant coronary aneurysms after prolonged anti-inflammatory treatment

Abstract

The patient is a 5-year-old male with Kawasaki disease, whose involution of giant aneurysms of the left coronary arteries was surprising after a prolonged period of treatment, which lasted 80 uninterrupted days and comprised anti-inflammatory drugs associated with anticoagulation agents. The distal diameters of the anterior interventricular, the diagonal, and the circumflex arteries normalized by the end of the treatment. A residual giant aneurysm localized at the beginning of the anterior interventricular artery did not cause ischemia. Continuation of the medication for a prolonged period was recommended.Kawasaki disease, known since 1976 1 , has some evolutional characteristics that deserve mention 2-6 , among which is the reduction in coronary aneurysms with adequate anti-inflammatory treatment, which causes radical change both in the size and extension of the aneurysm, except for the rare regression of giant aneurysms 2,3,6 . This involution is possible and may even be significant in some cases. Therefore, in the acute phase of the disease, surgical indication, which is limited to the presence of significant dysfunction or myocardial ischemia, or both, should be very carefully considered 4,5 .We report a case of significant involution of giant coronary aneurysms with treatment. Case ReportThe patient is a 5-year-old male with findings suggestive of Kawasaki disease in the preceding 2 months, characterized by fever, enlargement of cervical lymph nodes, and tonsillitis, followed by generalized cutaneous erythema, pruritus, and edema of the limbs after a few days, and desquamation on the 10th day. The laboratory tests indicated an active inflammatory phase with an elevated sedimentation rate of 100 mm during the first minute, C-reactive protein of 50 U, leukocytosis of 12000/mm 3 , and, approximately 10 days later, an increased number of platelets (540000/mm 3 ). Despite the treatment with acetylsalicylic acid (80mg/kg/ day), gamma globulin (2g/kg) on the forth and seventh days, in addition to general measures, the patient developed giant aneurysms in the anterior interventricular, circumflex, and right coronary arteries. These aneurysms were detected in the initial third of the cited arteries on echocardiography ( fig. 1) approximately 33 days after the beginning of the disease and were confirmed on coronary angiographic study on the 46th day of evolution, in which the right coronary artery was obstructed and filled retrogradely from the left coronary artery. The left arteries were significantly dilated halfway up their trajectories, and saccular aneurysms continued the anterior interventricular artery up to the left ventricular tip. The diagonal artery was slightly impaired ( fig. 2).Due to persistence of the elevated sedimentation rate and C-reactive protein, the treatment with high doses of acetylsalicylic acid was reinitiated on the 47th day after the beginning of the disease, interrupted on the 17th day due to gastric irritation. Laboratory tests became normal 20 days after the restart of medication, whic...

I misteri che circondano la malattia di Kawasaki: una recensione della letteratura

“…La condizione suggestiva della patologia è caratterizzata da febbre, aumento dei linfonodi cervicali e tonsillite, seguita da eritema cutaneo generalizzato, prurito ed edema degli arti e dopo alcuni giorni di sfaldamento. I test di laboratorio mostrano una fase infiammatoria attiva con alto tasso di sedimentazione, proteina C-reattiva, leucocitosi e aumento del numero di piastrine, che porta alla letargia dell'individuo interessato, poiché l'infiammazione può causare forti dolori (ALMEIDA, 2018;ATIK;FORONDA;BUSTAMANTE, 2003;FERRONATO et al, 2010;ROSSI et al, 2015).…”

Los misterios que rodean la enfermedad de Kawasaki: Una revisión de la literatura

“…La afección sugerente de la patología se caracteriza por fiebre, aumento de los ganglios linfáticos cervicales y amigdalitis, seguido de eritema cutáneo generalizado, picazón y edema de las extremidades y después de unos días de descamación. Las pruebas de laboratorio muestran una fase inflamatoria activa con alta tasa de sedimentación, proteína C reactiva, leucocitosis y un mayor número de plaquetas, lo que conduce al letargo del individuo afectado, ya que la inflamación puede causar dolor intenso (ALMEIDA, 2018;ATIK;FORONDA;BUSTAMANTE, 2003;FERRONATO et al, 2010;ROSSI et al, 2015).…”