Two Cases of New Coronary Aneurysms That Developed in the Late Period After Kawasaki Disease
- PDF / 327,306 Bytes
- 4 Pages / 595.276 x 790.866 pts Page_size
- 50 Downloads / 151 Views
CASE REPORT
Two Cases of New Coronary Aneurysms That Developed in the Late Period After Kawasaki Disease Junichi Ozawa • Hiroshi Suzuki • Satoshi Hasegawa • Fujito Numano • Hisanori Haniu • Kenichi Watanabe • Makoto Uchiyama • Akihiko Saitoh
Received: 4 July 2012 / Accepted: 25 September 2012 Ó Springer Science+Business Media New York 2012
Abstract Two cases of coronary aneurysm developed in the late period after Kawasaki disease (KD). Case 1 involved a 13-year-old boy who had aneurysms develop after a diagnosis of complete regression. Case 2 involved a 29-year-old man who had a new aneurysm develop after he was older than 20 years. Physicians need to be aware that coronary aneurysms can develop in patients with antecedent KD even after regression or in adulthood. Keywords Coronary aneurysm Kawasaki disease Late period
Introduction Kawasaki disease (KD) is an acute self-limited vasculitis, causing coronary aneurysms in approximately 10 % of patients during the acute phase [4]. Subsequently, most of the aneurysms regress, change into stenotic lesions, or persist. The diameter of persistent aneurysms may increase slightly because of somatic growth, or it may decrease because of intimal thickening of the vascular wall [5, 9]. Recent studies have reported new or expanding aneurysms in the late period after KD [3, 5–9, 12]. The clinical aspects and the mechanisms of coronary aneurysm progression have not been understood to date. We report two cases of new coronary aneurysms that developed in the late period after KD.
Case Reports Case 1 A 13-year-old boy with a diagnosis of KD since the age of 14 months experienced a fever of 18 days duration despite intravenous immunoglobulin (IVIG) therapy in the acute phase. His maximum white blood cell count was 20,200/lL, and his C-reactive protein level was 6 mg/L. Dilations were observed on the left main trunk (LMT) and the right coronary artery (RCA) by two-dimensional echocardiography 2 months after the onset of KD. The maximum diameter of the dilations on both the LMT and the RCA was 3.1 mm. We administered aspirin from the acute phase. A coronary angiogram 7 months after the onset of KD showed that the boy’s dilations had completely regressed (Fig. 1a, b). He had been monitored without medication until he was 6 years old, and no cardiac events had occurred thereafter. Unexpectedly, follow-up echocardiography 10 years after the onset of KD showed an RCA aneurysm. Computed tomography and a coronary angiogram demonstrated dilation of segment 1 and an aneurysm of segment 2 (Fig. 1c, d). The maximum diameter of segment 1 was 7.7 mm, and that of segment 2 was 8.2 mm. Computed tomography demonstrated no wall abnormalities or calcification in the new aneurysm. We resumed aspirin therapy.
Case 2 J. Ozawa (&) H. Suzuki S. Hasegawa F. Numano H. Haniu K. Watanabe M. Uchiyama A. Saitoh Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori Chuo-ku, Niigata 951-8510, Japan e-mail: [email protected]
A 29-ye
Data Loading...
