An Acute Thrombus Formation in the Left Coronary Artery of an Atypical Kawasaki Patient
Abstract
Kawasaki disease (KD) is a self-limited syndrome with serious heart complications, mostly seen in children of age 5-month to 4-year-old. KD needs to be diagnosed soon to start IVIG within 10 days of starting symptoms to lower heart complications to 5 folds. Our case, a 2-year-old boy presented with prolonged fever and pharyngeal erythema. In early evaluation, erythrocyte sedimentation rate (ESR) was elevated, and after that, Color Doppler echocardiography with suspicion for KD was performed and showed aneurysm and thrombosis formation in the left coronary artery (LCA). Hence, intravenous immunoglobulin (IVIG) was started for the patient concurrent with daily check of troponin I level. In this case report, we present remarkable echocardiographic findings of a patient with the delay in diagnosis of KD demonstrating an aneurysm and acute thrombus formation in LCA.
Kavey R-EW, Allada V, Daniels SR, Hayman LL, McCrindle BW, Newburger JW, et al. Cardiovascular Risk Reduction in High-Risk Pediatric Patients*. J Cardiovasc Nurs. 2007 May;22(3):218–53.
Gomard-Mennesson E, Landron C, Dauphin C, Epaulard O, Petit C, Green L, et al. Kawasaki disease in adults: report of 10 cases. Medicine (Baltimore). 2010;89(3):149–58.
Yim D, Curtis N, Cheung M, Burgner D. Update on Kawasaki disease: Epidemiology, aetiology and pathogenesis. J Paediatr Child Health. 2013;49(9):704–8.
Newburger JW, Takahashi M, Burns JC. Kawasaki Disease. J Am Coll Cardiol. Elsevier; 2016;67(14):1738–49.
Hartopo AB, Setianto BY. Coronary artery sequel of kawasaki disease in adulthood, a concern for internists and cardiologists. Acta Med Indones. 2013;45(1):69–75.
Hirono K, Kemmotsu Y, Wittkowski H, Foell D, Saito K, Ibuki K, et al. Infliximab reduces the cytokine-mediated inflammation but does not suppress cellular infiltration of the vessel wall in refractory kawasaki disease. Pediatr Res. 2009;65(6):696–701.
De Rosa G, Cefalo MG, Marano R, Piastra M, Delogu AB, Rigante D. Delayed diagnosis of Kawasaki syndrome and thrombosis of a medium-sized aneurysm of the anterior descending coronary artery: Case report and literature review. Rheumatol Int. 2012;32(3):809–14.
Patel RM, Shulman ST. Kawasaki disease: A comprehensive review of treatment options. J Clin Pharm Ther. 2015;40(6):620–5.
Sánchez-Manubens J, Bou R, Anton J. Diagnosis and classification of Kawasaki disease. J Autoimmun. 2014;48–49:113–7.
Gamillscheg A, Zobel G, Karpf EF, Dacar D, Beitzke A, Stein JI, et al. Atypical presentation of Kawasaki disease in an infant. Pediatr Cardiol. Springer-Verlag; 1993 Oct;14(4):223–6.
O’Brien M, Parness IA, Neufeld EJ, Baker AL, Sundel RP, Newburger JW. Ticlopidine plus aspirin for coronary thrombosis in Kawasaki disease. Pediatrics. 2000;105(5):E64.
Heaton P, Wilson N. Fatal Kawasaki disease caused by early occlusive coronary artery disease. Arch Dis Child. BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health; 2002 Aug;87(2):145–6.
Sivakumar K, Pavithran S. Extensive coronary aneurysms with thrombosis in resistant Kawasaki disease. Pediatr Cardiol. 2013;34(2):444–6.
Jone P-N, Tapia D, Davidson J, Fagan TE, Browne L, Ing RJ, et al. Successful Treatment of Myocardial Infarction in an Infant With Kawasaki Disease. Semin Cardiothorac Vasc Anesth. 2015;19(3):255–9.
Song G, Ren W, Liu Z, Wu D. Incomplete Kawasaki disease with coronary artery aneurysm and coronary sinus thrombus. Pediatr Cardiol. 2015;36(5):1097–9.
Koren G, Lavi S, Rose V RR. Kawasaki disease: review of risk factors for coronary aneurysms. J Pediatr. 1986;108:388–392.
Belay ED, Maddox R a, Holman RC, Curns AT, Ballah K, Schonberger LB. Kawasaki syndrome and risk factors for coronary artery abnormalities: United States, 1994-2003. Padiatr Infect Dis J. 2006;25(3):245–9.
| Files | ||
| Issue | Vol 56, No 5 (2018) | |
| Section | Case Report(s) | |
| Keywords | ||
| Kawasaki disease Fever Thrombosis formation Heart aneurysm | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
