Coronary Artery Involvement Following Kawasaki Disease: A Case Report of a 5 Month Old African Infant

Abstract

Background: Kawasaki disease (KD) is an acute systemic vasculitis which progresses to cause coronary artery abnormalities as a complication. Echocardiographic and cardiac angiographic data indicate that 20-40% of untreated KD patients develop coronary artery abnormalities. However, majority of the lesions regress over time. Timely treatment with high dose intravenous immunoglobulins (IVIG) and high dose of aspirin has been found to reduce the incidence of developing coronary artery aneurysms to 2%-3%. Data on KD in the African region is unavailable. We present a case of a 5 month old infant that presented at the Uganda Heart Institute with KD associated with coronary artery involvement and is currently undergoing follow up. Case presentation: A 5-months-old female infant presented to the pediatric emergency unit with a persistent high grade fever for 7 days with refusal to breast feed, diarrhea and irritability, a generalized maculopapular rash that had started 2 days after onset of fever. Her vaccination status was up to date. She was evaluated and initially managed for gastroenteritis and septicemia with no improvement. A pediatric cardiology review was done at day 22 of illness due to symptoms of difficulty in breathing and palpitations. Significant physical findings were of a very sick infant, febrile with generalized maculopapular rash, peeling of extremities and perineum, hyperemia of the conjunctiva bilaterally and the pharynx, no cervical lymphadenopathy. She had tachypnea, tachycardia with a gallop rhythm but no murmurs, tender hepatomegally, irritability but conscious with no signs of meningeal irritation. A transthoracic echocardiography done significantly showed dilated coronary arteries, moderate pericardial effusion with preserved ejection fraction. Laboratory findings were of leucocytosis predominantly neutrophilia, thrombocytosis, anemia, raised C-reactive protein levels, hypoalbuminemia and raised liver function tests. Blood cultures and blood smear for malaria were unremarkable. A diagnosis of KD with coronary artery involvement was made by the pediatric cardiologist. Treatment for KD was started immediately with high dose intravenous immunoglobulins (IVIG) as a single dose and high dose aspirin with remarkable improvement as the fever subsided with in 24 hours of treatment. Follow up serial transthoracic echocardiography findings showed regression of coronary artery dilatation over time and currently at 3 years of age the coronary arteries are of normal diameter for her body surface area. ISSN: 2643-3966 DOI: 10.23937/2643-3966/1710025 Hilda et al. Int Arch Cardiovasc Dis 2019, 3:025 • Page 2 of 5 • month-old infant with coronary artery involvement in Uganda in Africa.