Successful Emergent Coronary Thrombolysis in a Neonate with Kawasaki’s Disease

Karia, Vijay R.; Hescock, George; Gedelia, Abraham; Ross-Ascuitto, Nancy

doi:10.1007/s00246-010-9781-y

Cited by 8 publications

(4 citation statements)

References 11 publications

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“…Our literature search revealed only a few reported cases of suspected NKD worldwide (18 cases, including 14 English literature and 4 Chinese literature) (Table 1) [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], together with this case, 19 cases in total. In all the presented cases including ours, 12 were male and 7 were female, the age of onset was 1-26 days.…”

Section: Discussionmentioning

confidence: 99%

Neonatal Kawasaki Disease: Case Report and Literature Review

Wang

et al. 2020

Preprint

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Background: Kawasaki Disease (KD) is a self-limiting and acute systemic vasculitis of childhood that leads to coronary artery abnormality in about 25% of untreated cases. KD is extremely rare in neonates. The purpose of this paper is to explore the clinical features and diagnosis and treatment of Neonatal Kawasaki Disease (NKD) for early identification. Case presentation: A boy was a 24-day-old full-term infant with no special birth history. He had fever, irritability and rash at the time of admission. After 4 days of treatment with empirical antibiotics, the rash and fever were still present, and the rash was progressively increased. It is considered that the infection was serious, and antibiotics were changed and given intravenous immunoglobulin. The temperature and rash were better than before. On day 5, he had cracking of lips, on day 9, he had lymph node enlargement in the neck, and molted fingers appeared on the 10th day. Thus the complete Kawasaki Disease (CKD) was diagnosed, and the patient was given intravenous immunoglobulin (IVIG) and aspirin. Within 48h after the start of this therapy, the fever declined, the chapped lips got better, the rash resolved, and distal extremity desquamation appeared. On day 5, 13, and 18, there was no abnormality in echocardiography and no coronary dilatation. On day 20, the chapped lips and the distal extremity desquamation got better. After discharge, the patient continued to take aspirin orally. The patient was followed up to 1 year old, with good prognosis and no carditis or coronary artery abnormalities. Our literature search revealed only a few reported cases of suspected NKD worldwide (18 cases, including 14 English literature and 4 Chinese literature) (Table 1), together with this case, 19 cases in total. Among these 19 cases, 12 were male and 7 were female, the age of onset was 1-26 days. Six patients had complete KD (31.5%), 13 patients were IKD. Clinical manifestations: there were 17 cases of fever (89.5%, 13cases of fever >5days), 13cases (68.4%) of early limb edema/swelling or peeling, 16 cases (84.2%)of skin rash, 14cases (73.7%)of oral mucosal changes (lips red/cleft or strawberry tongue), 10 cases (53%) of coronary artery changes, 7cases (36.8%) of conjunctival congestion, 3cases（15.8%）of cervical lymph node enlargement. Laboratory investigations: There were 5 cases (35.7%) with elevated ESR, 9 cases normal, 5cases unknown. CRP was normal in 6 cases (33%). Thrombocytopenia occurred in 11cases (64.7%). Among the 10 patients with coronary artery changes, 1 had an unknown prognosis due to loss of follow-up (patient 15). One patient died 2 days after discharge due to multiple organ failure (patient 17). 4 cases returned to normal (patient 3.6.7.14). The coronary artery changes in 4 cases still did not return to normal and were not followed up for a long time. Of the 19 NKD patients, 16 were sensitive to IVIG, 1did not use IVIG, and 1 was not sensitive to IVIG，and due to multiple organ failure, the parents gave up treatment and died two days after discharge.Conclusion: NKD is extremely rare, and its clinical manifestation is not typical and easy to be missed. If not treated early, it will potentially give rise to coronary artery aneurysms or expansion, ischemic heart disease, and sudden death. Early diagnosis and treatment are very important.

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Section: Discussionmentioning

confidence: 99%

Neonatal Kawasaki Disease: Case Report and Literature Review

Wang

et al. 2020

Preprint

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“…Thrombolytic agents such as urokinase and rT-PA have been used to treat acute myocardial ischemia secondary to thrombus formation in CAAs of patients with KD [5,10,14]. Improved outcome was reported when the agents were administered directly into the coronary arteries [5,15].…”

Section: Discussionmentioning

confidence: 99%

“…Ariyoshi et al [4] reported three cases, in patients aged 20-35 years, in whom primary percutaneous coronary interventions in combination with intracoronary thrombolysis proved to be safe and effective in acute myocardial infarction. Karia et al [14] reported a 29-day-old child with KD who presented with multiple medium-size CAAs as well as coronary thromboses, myocardial ischemia, and congestive heart failure. The infant successfully underwent intracoronary infusion of rT-PA.…”

Section: Discussionmentioning

confidence: 99%

Successful Revascularization of a Completely Occluded Right Coronary Artery by Local Thrombus Fragmentation, Thrombolysis, Thrombus Aspiration and Balloon Angioplasty in a Patient with Atypical Kawasaki Disease

Haas¹

2016

jshd

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Background: The clinical presentation of atypical Kawasaki disease (KD) is variable; thus, an accurate diagnosis may be missed. With intravenous immunoglobulin therapy, the risk of coronary arterial lesions has been reduced from 20-25% to about 5%. Coronary artery aneurysms may remain clinically silent, but thrombosis may result in acute myocardial infarction. We report a case with complete occlusion of the right coronary artery (RCA) due to thrombosis of large aneurysms and severe stenoses after atypical KD. Methods: A 10-year-old boy was admitted to our tertiary medical center after two episodes of ventricular fibrillation caused by acute myocardial infarction. Results: Coronary angiography showed aneurysms of the left coronary artery and a completely occluded RCA. Transcatheter revascularization was achieved by a combination of mechanical thrombus fragmentation, intracoronary thrombolysis, thrombus aspiration, and balloon angioplasty of two stenosed areas of the RCA, resulting in complete reperfusion. The child´s past medical history revealed the diagnosis of untreated atypical KD 6 months previously. Conclusions: There are few reports of coronary interventions after KD in young patients. Coronary artery abnormalities include persistent aneurysms with the risk of thrombosis and progressive stenosis. However, no confirmed treatment guidelines exist for this particular patient group. Based on the highly variable anatomy of the coronary arteries, an individualized therapy using the full armamentarium of endovascular treatments may be necessary. This case study suggests that primary percutaneous coronary intervention using a targeted approach might be safe and effective in the treatment of acute myocardial infarction after KD.

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“…Kawasaki disease (KD) is a self-limiting systemic vasculitis of unknown etiology that typically occurs in children aged between 6 months and 5 years [1]. It is much less common under 3 months of age and extraordinarily rare in the neonatal period [2][3][4][5][6][7][8]. A 12-year Japanese nationwide survey reported only 23 cases of neonatal KD [2], while only about 10 neonatal cases have been reported in other countries in the English-language literature [4].…”

Section: Introductionmentioning

confidence: 99%

Neonatal Kawasaki disease with multiple arterial aneurysms: a case report

Zhao

Liang

et al. 2020

Pediatr Rheumatol

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Background: Kawasaki disease (KD) is a medium vessel vasculitis that typically occurs in children aged between 6 months and 5 years. It is extraordinarily rare in the neonatal period. KD-related systemic artery aneurysms (SAAs) have never been reported in neonates. Case presentation: A male infant was transferred to our institution for persistent high-grade fever lasting 16 days. Symptoms started at day 14 of life, and he was admitted to a children's hospital on the second day of fever. Physical examination at the time found no signs suggestive of KD. The only laboratory parameters which were of significance were values suggestive of systemic inflammation. However, his fever persisted and inflammatory markers continued to rise despite 2 weeks of antibiotic therapy. KD as a noninfectious cause of fever was considered when he came to our institution, and echocardiographic findings of left and right medium coronary artery aneurysms (CAAs) confirmed our suspicions. Full-body magnetic resonance angiography also revealed bilateral axillary artery aneurysms. Administration of intravenous gamma globulin resulted in rapid improvement. His fever resolved on the next day and CAAs and SAAs regressed to normal at 6 months and 3 months after diagnosis, respectively. Conclusion: This unique case of incomplete KD highlights the importance of considering KD in neonates with unexplained prolonged fever and reinforces the need to remain vigilant for SAAs in KD.

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Successful Emergent Coronary Thrombolysis in a Neonate with Kawasaki’s Disease

Cited by 8 publications

References 11 publications

Neonatal Kawasaki Disease: Case Report and Literature Review

Neonatal Kawasaki Disease: Case Report and Literature Review

Successful Revascularization of a Completely Occluded Right Coronary Artery by Local Thrombus Fragmentation, Thrombolysis, Thrombus Aspiration and Balloon Angioplasty in a Patient with Atypical Kawasaki Disease

Neonatal Kawasaki disease with multiple arterial aneurysms: a case report

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