Refractory Progression of Coronary Aneurysms, a Case of Delayed Onset Kawasaki Disease as Depicted by Cardiac Computed Tomography Angiography

Azmoon, Shah; Atkinson, David; Budoff, Matthew J.

doi:10.1111/j.1747-0803.2009.00361.x

Cited by 6 publications

(4 citation statements)

References 35 publications

(82 reference statements)

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“…So far, KD is diagnosed based primarily on the clinical features; there are no specific laboratory tests for the early identification and diagnosis 4 . However, delay accurate diagnosis may cause increased mortality and morbidity from complications of KD 5 . Previous studies indicated that thrombocytosis is common in the subacute stage of KD patients 6–8 .…”

Section: Introductionmentioning

confidence: 99%

Changes in and significance of platelet function and parameters in Kawasaki disease

Zheng

Zhang

et al. 2019

Sci Rep

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Kawasaki disease (KD) is a systemic febrile, inflammatory vascular disease of unknown etiology. The coronary artery abnormality (CAA) caused by KD has become the most commonly acquired heart disease in children. Initial treatment of intravenous immunoglobulin (IVIG) can reduce the incidence of CAA. Thrombocytosis is common during the course of KD, but changes in and significances of platelet function and parameters are unclear. In this study, we enrolled 120 patients, including 40 patients with KD, 40 febrile controls, and 40 afebrile controls. The platelet function was assessed using the platelet function analyzer (PFA)-200. Platelet parameters, including platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), and platelet hematocrit (PCT) were measured. In the febrile period, the PDW and MPV were lower in KD patients (P < 0.05). The platelet function did not change significantly during the febrile period of KD but weakened in the defervescence phase. No significant differences between the CAA and normal groups, and between IVIG resistance and response groups. The diagnostic cutoff value of the PDW level for predicting KD was 10.85 fL with a sensitivity of 55% and a specificity of 77.5% (area under curve (AUC) = 0.690, 95% confidence interval (CI): 0.574–0.806, P < 0.01). Besides, the MPV level was 9.55 fL with sensitivity of 75% and specificity of 70% (AUC = 0.733, 95%CI: 0.620–0.846, P < 0.001). This is the first longitudinal study of platelet function changes in KD patients using PFA-200. Besides, lower PDW and MPV may be available markers for early diagnosis of KD.

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Section: Introductionmentioning

confidence: 99%

Changes in and significance of platelet function and parameters in Kawasaki disease

Zheng

Zhang

et al. 2019

Sci Rep

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“…It is mostly used in both acute and chronic phases of KD. Newer generation computed tomographic (CT) scanners provide detailed information on the arterial location, size, structure, and number of CAAs with improved spatial resolution and better image quality [ 2 , 12 , 13 ]. As per the technical advancements in imaging, the radiation dose used was significantly lower for imaging with a 256-slice CT scanner at a heart rate (HR) of 132 bpm.…”

Section: Discussionmentioning

confidence: 99%

Cardiac CT Angiography-Guided Management of Giant Coronary Artery Aneurysms in Atypical Kawasaki Disease: A Case Report and Review of Literature

Muddana,

Munugala

et al. 2023

Cureus

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Kawasaki disease (KD) is an auto-immune, acute febrile illness mostly affecting young children. It may develop into vasculitis characterized by coronary artery aneurysms (CAA) if not diagnosed and managed earlier. Timely diagnosis and appropriate treatment eventually avoid the risk of the development of CAA. We present the case of a 21-month-old female child with a history of persistent fever for nearly 10 days who further developed desquamations and presented for cardiac evaluation. Atypical KD with the development of giant CAAs was effectively diagnosed by cardiac computed tomographic angiography (CCTA) and was appropriately managed.

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“…However, treating refractory KD with IVMP should be undertaken with caution because of adverse effects 12). Steroid treatment has also been associated with the development of CAA or rupture in many case reports 13)14)15)16). A recent study shows that IVIG-resistant patients with alternative corticosteroid therapy more frequently develop coronary artery lesion (CAL) than those without corticosteroid therapy 17).…”

Section: Discussionmentioning

confidence: 99%

Infliximab Treatment for Intravenous Immunoglobulin-resistant Kawasaki Disease: a Multicenter Study in Korea

et al. 2019

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Background and ObjectivesWe investigated the status of infliximab use in intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD) patients and the incidence of coronary artery aneurysms (CAAs) according to treatment regimens.MethodsBetween March 2010 and February 2017, 16 hospitals participated in this study. A total of 102 (32.3±19.9 months, 72 males) who received infliximab at any time after first IVIG treatment failure were enrolled. Data were retrospectively collected using a questionnaire.ResultsSubjects were divided into two groups according to the timing of infliximab administration. Early treatment (group 1) had shorter fever duration (10.5±4.4 days) until infliximab infusion than that in late treatment (group 2) (16.4±4.5 days; p<0.001). We investigated the response rate to infliximab and the incidence of significant CAA (z-score >5). Overall response rate to infliximab was 89/102 (87.3%) and the incidence of significant CAA was lower in group 1 than in group 2 (1/42 [2.4%] vs. 17/60 [28.3%], p<0.001).ConclusionsThis study suggests that the early administration of infliximab may reduce the incidence of significant CAA in patients with IVIG-resistant KD. However, further prospective randomized studies with larger sample sizes are required.

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Refractory Progression of Coronary Aneurysms, a Case of Delayed Onset Kawasaki Disease as Depicted by Cardiac Computed Tomography Angiography

Cited by 6 publications

References 35 publications

Changes in and significance of platelet function and parameters in Kawasaki disease

Changes in and significance of platelet function and parameters in Kawasaki disease

Cardiac CT Angiography-Guided Management of Giant Coronary Artery Aneurysms in Atypical Kawasaki Disease: A Case Report and Review of Literature

Infliximab Treatment for Intravenous Immunoglobulin-resistant Kawasaki Disease: a Multicenter Study in Korea

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