Coronary Artery Aneurysms After Adult-Onset Kawasaki Disease
2013; Lippincott Williams & Wilkins; Volume: 127; Issue: 15 Linguagem: Inglês
10.1161/circulationaha.112.130153
ISSN1524-4539
AutoresRyota Inokuchi, Hideaki Kurata, Masaki Harada, Yuta Aoki, Takehiro Matsubara, Kent Doi, Takeshi Ishii, Masataka Gunshin, Takahiro Hiruma, Susumu Nakajima, Naoki Yahagi,
Tópico(s)Cardiovascular Issues in Pregnancy
ResumoHomeCirculationVol. 127, No. 15Coronary Artery Aneurysms After Adult-Onset Kawasaki Disease Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBCoronary Artery Aneurysms After Adult-Onset Kawasaki Disease Ryota Inokuchi, MD, Hideaki Kurata, MD, Masaki Harada, MD, Yuta Aoki, MD, Takehiro Matsubara, MD, PhD, Kent Doi, MD, PhD, Takeshi Ishii, MD, Masataka Gunshin, MD, Takahiro Hiruma, MD, Susumu Nakajima, MD, PhD and Naoki Yahagi, MD, PhD Ryota InokuchiRyota Inokuchi From the Department of Emergency Medicine, Haibara General Hospital, Shizuoka, Japan (R.I., H.K.); Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan (R.I., H.K., Y.A., T.M., K.D., TI., M.G., T.H., S.N., N.Y.); and the Department of Cardiology, Haibara General Hospital, Shizuoka, Japan (M.H.). , Hideaki KurataHideaki Kurata From the Department of Emergency Medicine, Haibara General Hospital, Shizuoka, Japan (R.I., H.K.); Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan (R.I., H.K., Y.A., T.M., K.D., TI., M.G., T.H., S.N., N.Y.); and the Department of Cardiology, Haibara General Hospital, Shizuoka, Japan (M.H.). , Masaki HaradaMasaki Harada From the Department of Emergency Medicine, Haibara General Hospital, Shizuoka, Japan (R.I., H.K.); Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan (R.I., H.K., Y.A., T.M., K.D., TI., M.G., T.H., S.N., N.Y.); and the Department of Cardiology, Haibara General Hospital, Shizuoka, Japan (M.H.). , Yuta AokiYuta Aoki From the Department of Emergency Medicine, Haibara General Hospital, Shizuoka, Japan (R.I., H.K.); Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan (R.I., H.K., Y.A., T.M., K.D., TI., M.G., T.H., S.N., N.Y.); and the Department of Cardiology, Haibara General Hospital, Shizuoka, Japan (M.H.). , Takehiro MatsubaraTakehiro Matsubara From the Department of Emergency Medicine, Haibara General Hospital, Shizuoka, Japan (R.I., H.K.); Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan (R.I., H.K., Y.A., T.M., K.D., TI., M.G., T.H., S.N., N.Y.); and the Department of Cardiology, Haibara General Hospital, Shizuoka, Japan (M.H.). , Kent DoiKent Doi From the Department of Emergency Medicine, Haibara General Hospital, Shizuoka, Japan (R.I., H.K.); Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan (R.I., H.K., Y.A., T.M., K.D., TI., M.G., T.H., S.N., N.Y.); and the Department of Cardiology, Haibara General Hospital, Shizuoka, Japan (M.H.). , Takeshi IshiiTakeshi Ishii From the Department of Emergency Medicine, Haibara General Hospital, Shizuoka, Japan (R.I., H.K.); Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan (R.I., H.K., Y.A., T.M., K.D., TI., M.G., T.H., S.N., N.Y.); and the Department of Cardiology, Haibara General Hospital, Shizuoka, Japan (M.H.). , Masataka GunshinMasataka Gunshin From the Department of Emergency Medicine, Haibara General Hospital, Shizuoka, Japan (R.I., H.K.); Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan (R.I., H.K., Y.A., T.M., K.D., TI., M.G., T.H., S.N., N.Y.); and the Department of Cardiology, Haibara General Hospital, Shizuoka, Japan (M.H.). , Takahiro HirumaTakahiro Hiruma From the Department of Emergency Medicine, Haibara General Hospital, Shizuoka, Japan (R.I., H.K.); Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan (R.I., H.K., Y.A., T.M., K.D., TI., M.G., T.H., S.N., N.Y.); and the Department of Cardiology, Haibara General Hospital, Shizuoka, Japan (M.H.). , Susumu NakajimaSusumu Nakajima From the Department of Emergency Medicine, Haibara General Hospital, Shizuoka, Japan (R.I., H.K.); Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan (R.I., H.K., Y.A., T.M., K.D., TI., M.G., T.H., S.N., N.Y.); and the Department of Cardiology, Haibara General Hospital, Shizuoka, Japan (M.H.). and Naoki YahagiNaoki Yahagi From the Department of Emergency Medicine, Haibara General Hospital, Shizuoka, Japan (R.I., H.K.); Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan (R.I., H.K., Y.A., T.M., K.D., TI., M.G., T.H., S.N., N.Y.); and the Department of Cardiology, Haibara General Hospital, Shizuoka, Japan (M.H.). Originally published16 Apr 2013https://doi.org/10.1161/CIRCULATIONAHA.112.130153Circulation. 2013;127:1636–1637In May 2012, we encountered a rare case of adult-onset Kawasaki disease (KD) with coronary artery abnormalities in a 24-year-old Japanese man. The patient presented with recent-onset chest pain that occurred when he was at rest and no other symptoms. His medical history included hospitalization 2 years before the present admission, at another hospital, because of a fever of unknown origin that lasted for 2 weeks, accompanied by polymorphic exanthema, cervical lymphadenopathy, nonpurulent conjunctivitis, strawberry tongue, and fingertip desquamation. At that time, the patient was diagnosed with adult-onset Still's disease. On the basis of that diagnosis, he was treated with steroid pulse therapy alone, and his symptoms were alleviated. After 2 months, he received oral steroid therapy and was assumed to have been treated successfully; however, the patient was admitted to our hospital 20 months after concluding the oral steroid therapy.On admission to our hospital, KD was suspected because of his past history of "strawberry tongue," which is unique to this disease.1 The chest pain was associated with an abnormal ECG that showed an abnormal Q wave in the inferior (II, III, aVF) ECG zones (Figure 1). A cardiac 3-dimensional computed tomography scan showed an aneurysm of the proximal right coronary artery, with tight postaneurysmal stenosis. The scan also showed proximal aneurysms of the left anterior descending artery and the proximal circumflex artery (Figure 2). He was treated with percutaneous coronary intervention and discharged on day 28 without any complications.Download figureDownload PowerPointFigure 1. Twelve-lead ECG showing an abnormal Q wave in the inferior (II, III, aVF) ECG zones.Download figureDownload PowerPointFigure 2. Cardiac 3-dimensional computed tomography scan showing an aneurysm of the proximal right coronary artery, with tight postaneurysmal stenosis, and a proximal aneurysm of both the left anterior descending artery and the proximal circumflex artery.Typical KD findings in both adults and children include fever, conjunctivitis, pharyngitis, skin erythema progressing to a desquamating rash on the palms and soles, and strawberry tongue. Adults more frequently present with cervical adenopathy (93% of adults versus 15% of children), hepatitis (65% versus 10%), and arthralgia (61% versus 24% to 38%). In contrast, adults are less frequently affected by meningitis (10% versus 34%), thrombocytosis (55% versus 100%), and coronary artery aneurysms (5% versus 18%– 25%).2KD is a common vasculitis of childhood, but adult-onset KD is rare. No specific diagnostic tests are available for KD; the diagnosis is based on the presence of characteristic clinical findings. In addition, a consensus does not exist regarding the treatment of adult-onset KD. The treatment of KD with high-dose intravenous immunoglobulin within the first 10 days of illness reportedly decreases the prevalence of coronary artery aneurysms in childhood. Recently, the incidence of coronary artery abnormalities was reported to be significantly lower in pediatric patients receiving intravenous immunoglobulin plus prednisolone therapy than in those receiving only intravenous immunoglobulin therapy.3 Even patients with adult-onset KD have been reported to benefit from prompt intravenous immunoglobulin administration.4 However, according to one report that examined 91 patients, only 16.5% were diagnosed with adult-onset KD within 10 days of disease onset.4The low diagnostic accuracy for adult-onset KD, in contrast to that in pediatric patients, can be attributed to the several differential diagnoses that are possible in adult cases, including drug hypersensitivity reaction and toxic shock syndrome. Other potential diseases with similar symptomology include streptococcal infection (scarlet fever), leptospirosis, Mycoplasma and Rickettsiae diseases, adenoviral and other viral illnesses (eg, measles, rubella, Epstein-Barr virus infection, and fifth disease), toxoplasmosis, mercury poisoning (acrodynia), and rheumatologic disorders (Reiter syndrome, juvenile rheumatoid arthritis, and Still's disease).1,4 Careful attention to clinical details, such as the nature of the conjunctivitis, the presence of strawberry tongue, and a clinical history of any febrile illness in which the fever persists for >5 days and for which there is no obvious explanation, are required to make a correct diagnosis. Complicating the ability to make a correct clinical diagnosis, a growing body of evidence suggests that a number of children with KD do not fulfill the classic criteria used for KD diagnosis and that a few adult-onset KD cases also do not fulfill the classic criteria.4Once a differential diagnosis excludes the possibility of rheumatologic disorders or autoimmune disease, steroid therapy is often administered; however, treatment with steroids alone might have adverse effects in KD patients, causing progression of coronary lesions.4 In the present case, only steroid therapy was administered to the patient at the time of his initial hospitalization, 2 years earlier, and this may have resulted in an exacerbation of the patient's coronary artery abnormalities. Thus, the present report suggests that adult-onset KD should be considered as a differential diagnosis in cases presenting as rheumatologic disorders or autoimmune disease to prevent adverse effects caused by steroid treatment in adult-onset KD patients.DisclosuresNone.FootnotesCorrespondence to Ryota Inokuchi, MD, Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113–8655, Japan. E-mail [email protected]References1. Singh S, Kansra S. Kawasaki disease.Natl Med J India. 2005; 18:20–24.MedlineGoogle Scholar2. Wolff AE, Hansen KE, Zakowski L. Acute Kawasaki disease: not just for kids.J Gen Intern Med. 2007; 22:681–684.CrossrefMedlineGoogle Scholar3. Kobayashi T, Saji T, Otani T, Takeuchi K, Nakamura T, Arakawa H, Kato T, Hara T, Hamaoka K, Ogawa S, Miura M, Nomura Y, Fuse S, Ichida F, Seki M, Fukazawa R, Ogawa C, Furuno K, Tokunaga H, Takatsuki S, Hara S, Morikawa A; RAISE Study Group Investigators. Efficacy of immunoglobulin plus prednisolone for prevention of coronary artery abnormalities in severe Kawasaki disease (RAISE study): a randomised, open-label, blinded-endpoints trial.Lancet. 2012; 379:1613–1620.CrossrefMedlineGoogle Scholar4. Gomard-Mennesson E, Landron C, Dauphin C, Epaulard O, Petit C, Green L, Roblot P, Lusson JR, Broussolle C, Sève P. Kawasaki disease in adults: report of 10 cases.Medicine (Baltimore). 2010; 89:149–158.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Yang F, Ao X, Ding L, Ye L, Zhang X, Yang L, Zhao Z and Wang J (2022) Non‐coding RNAs in Kawasaki disease: Molecular mechanisms and clinical implications, BioEssays, 10.1002/bies.202100256, 44:6, (2100256), Online publication date: 1-Jun-2022. Ricketts E, Willcox M and Steele R (2017) Fever and a Morbilliform Rash, Clinical Pediatrics, 10.1177/0009922816687333, 57:2, (235-237), Online publication date: 1-Feb-2018. Boodoosingh N, Seecheran R, Varachhia S, Mack N, Minocha V, Giddings S and Seecheran N (2018) Incomplete Kawasaki Disease in an Adult South Asian Patient, Journal of Investigative Medicine High Impact Case Reports, 10.1177/2324709618792028, 6, (232470961879202), Online publication date: 1-Jan-2018. Fraison J, Sève P, Dauphin C, Mahr A, Gomard-Mennesson E, Varron L, Pugnet G, Landron C, Roblot P, Oziol E, Chalhoub G, Galempoix J, Humbert S, Humbert P, Sbidian E, Grange F, Bayrou O, Cathebras P, Morlat P, Epaulard O, Pavese P, Le Thi Huong D, Zoulim A, Stankovic K, Bachelez H, Smail A, Bachmeyer C, Granel B, Serratrice J, Brinchault G, Mekinian A, Costedoat-Chalumeau N, Bourgarit-Durand A, Puéchal X, Guillevin L, Piram M, Koné-Paut I and Fain O (2016) Kawasaki disease in adults: Observations in France and literature review, Autoimmunity Reviews, 10.1016/j.autrev.2015.11.010, 15:3, (242-249), Online publication date: 1-Mar-2016. Drago F, Javor S, Ciccarese G, Cozzani E and Parodi A (2015) A Case of Complete Adult-Onset Kawasaki Disease: A Review of Pathogenesis and Classification, Dermatology, 10.1159/000381911, 231:1, (5-8), . Kontopoulou T, Kontopoulos D, Vaidakis E and Mousoulis G (2015) Adult Kawasaki disease in a European patient: a case report and review of the literature, Journal of Medical Case Reports, 10.1186/s13256-015-0516-9, 9:1, Online publication date: 1-Dec-2015. Drago F, Javor S, Ciccarese G, Cozzani E and Parodi A (2015) Complete Kawasaki Disease in a 21-Year-Old Caucasian Patient, Case Reports in Clinical Medicine, 10.4236/crcm.2015.45035, 04:05, (175-178), . Serpytis P, Petrulioniene Z, Gargalskaite U, Gedminaite A and Panaviene V (2015) Myocardial Infarction Associated with Kawasaki Disease in Adult Man: Case Report and Review of Literature, The American Journal of Medicine, 10.1016/j.amjmed.2014.10.029, 128:3, (e1-e3), Online publication date: 1-Mar-2015. Moazzam A, Savvas S, Amar A, Ham S, Panush R and Clavijo L (2014) Diffuse aneurysmal disease – A review, Reviews in Vascular Medicine, 10.1016/j.rvm.2013.11.003, 2:2, (48-57), Online publication date: 1-Jun-2014. Sánchez-Manubens J, Bou R and Anton J (2014) Diagnosis and classification of Kawasaki disease, Journal of Autoimmunity, 10.1016/j.jaut.2014.01.010, 48-49, (113-117), Online publication date: 1-Feb-2014. Mohammed T, Saettele M, Saettele T, Patel V and Kanne J (2014) Eponyms in Cardiothoracic Radiology—Part II: Vascular, Current Problems in Diagnostic Radiology, 10.1067/j.cpradiol.2014.02.004, 43:4, (219-226), Online publication date: 1-Jul-2014. Azizi Z, Baharestani B, Gholampour Dehaki M, Yaghoubi A, Ghafarinejad M, Sadeghpour Tabaei A and Alizadeh Ghavidel A (2019) Clinical Characteristics and Surgical Outcomes of Coronary Artery Aneurysm: A Case Series, Multidisciplinary Cardiovascular Annals, 10.5812/mca.89833, In Press:In Press April 16, 2013Vol 127, Issue 15 Advertisement Article InformationMetrics © 2013 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.112.130153PMID: 23588962 Originally publishedApril 16, 2013 PDF download Advertisement SubjectsAcute Coronary SyndromesComputerized Tomography (CT)Imaging
Referência(s)