Giant Coronary and Systemic Aneurysms of Kawasaki Disease in an Infant

Excerpt

Kawasaki disease (KD) was diagnosed in a 4-month-old male infant after 4 days of fever, rash, and bulbar conjunctivitis. He received two doses of intravenous immunoglobulin (IVIG), high-dose oral acetylsalicylic acid, and three doses of methylprednisolone within in the first week of illness for persistent fever. During the third week of his illness, echocardiogram showed giant aneurysms at the origin of the right coronary artery (17 mm) and at the bifurcation of the left coronary artery (9 mm). Anticoagulant therapy was started. At 9-month follow-up, the child was clinically well, and there were no ST-T wave changes on electrocardiogram. Aortography showed a giant aneurysm (19 × 19 mm) at the origin of the right coronary artery and another aneurysm (9 × 17 mm) distally (Figs. 1 and 2). The left coronary artery showed a large aneurysm (10 × 6 mm) at the bifurcation (Fig. 1). There was no evidence of stenosis in the right or left coronary artery. Subclavian artery injections showed large aneurysms in both the right (8 × 12 mm) and left (12 × 24 mm) brachial arteries (Fig. 3). Abdominal and carotid angiography were normal. At present, the infant is being maintained on low-dose aspirin and anticoagulant therapy. The international normalized ratio (INR) has been maintained between 2 and 2.5 (Fig. 4).

…