Extensive coronary aneurysms with thrombosis in resistant Kawasaki disease

Pediatr Cardiol. 2013 Feb;34(2):444-6. doi: 10.1007/s00246-012-0285-9. Epub 2012 Mar 18.

Abstract

Giant coronary artery aneurysms that occur in 0.5 to 1% of patients with Kawasaki disease can be fatal if associated with thrombosis. Some patients may show persistent inflammation and fever despite treatment with repeated doses of intravenous immunoglobulin (IVIG), steroids, and aspirin. This report describes an infant boy with resistant Kawasaki disease who presented with extensive coronary artery involvement and coronary thrombosis. His inflammation was not controlled with multiple doses of IVIG, parenteral and oral steroids, or high-dose aspirin, and he finally needed infliximab, a monoclonal antibody against tumor necrosis factor alpha. The progression of coronary thrombosis was arrested by the platelet glycoprotein 2b/3a receptor blocker, abciximab, during the acute phase of the disease.

Publication types

  • Case Reports

MeSH terms

  • Administration, Oral
  • Anti-Inflammatory Agents / administration & dosage
  • Coronary Aneurysm / diagnosis
  • Coronary Aneurysm / drug therapy
  • Coronary Aneurysm / etiology*
  • Coronary Thrombosis / diagnosis
  • Coronary Thrombosis / drug therapy
  • Coronary Thrombosis / etiology*
  • Drug Resistance
  • Echocardiography
  • Electrocardiography
  • Follow-Up Studies
  • Humans
  • Immunoglobulins, Intravenous / administration & dosage
  • Immunoglobulins, Intravenous / therapeutic use*
  • Immunologic Factors / administration & dosage
  • Immunologic Factors / therapeutic use
  • Infant
  • Male
  • Mucocutaneous Lymph Node Syndrome / complications*
  • Mucocutaneous Lymph Node Syndrome / drug therapy

Substances

  • Anti-Inflammatory Agents
  • Immunoglobulins, Intravenous
  • Immunologic Factors