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Severe triple vessel coronary artery disease and aneurysms in a young white man: disease progression of childhood Kawasaki disease

Sivalingam, Senthil K; Parthasarathy, Hari K; Choong, Cliff K; Freeman, Leisa J

Journal of Cardiovascular Medicine: February 2009 - Volume 10 - Issue 2 - p 170–173
doi: 10.2459/JCM.0b013e32831b6de2
Case reports
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Kawasaki disease usually affects younger age groups, but cardiac sequelae of ‘missed’ (incomplete) childhood Kawasaki disease may first present in adult life. We report a case of a 28-year-old white man presenting with ST elevation myocardial infarction and later found to have triple vessel coronary artery aneurysmal disease, probably secondary to childhood Kawasaki disease for which he underwent cardiac bypass surgery. The patient has remained well and asymptomatic at 1-year follow-up. This case is highlighted as the incidence of Kawasaki disease is relatively low among the white population, and yet there are increasing reports of adult patients presenting with coronary artery aneurysmal disease secondary to childhood Kawasaki disease. There has been a relative paucity of reports of surgical revascularization for adult survivors of childhood Kawasaki disease. This report also emphasizes the importance of early recognition and aggressive treatment of the often missed, incomplete, form of Kawasaki disease, which may reduce the risk of late development of coronary artery aneurysms. There should be a high index of suspicion of Kawasaki disease in young adults presenting with aneurysmal coronary artery disease with no significant coronary risk factors and in the absence of generalized atherosclerosis.

aDepartment of Internal Medicine, Baystate Medical Center, Tufts University, Massachusetts, USA

bDepartment of Cardiology, UK

cDepartment of Cardiothoracic Surgery, Papworth Hospital NHS Foundation Trust, UK

dDepartment of Surgery, University of Cambridge, Cambridge, UK

eDepartment of Cardiology, Norfolk and Norwich University NHS Hospital, Norwich, UK

Received 18 June, 2008

Revised 29 September, 2008

Accepted 30 September, 2008

Correspondence to Dr Senthil K. Sivalingam, Department of Internal Medicine, Baystate Medical Center, Tufts University, 759 Chestnut Street, Springfield, MA 01199, USA Tel: +1 413 209 6272; fax: +1 413 794 8075; e-mail: senthilkumar_mmc@yahoo.com

© 2009 Italian Federation of Cardiology. All rights reserved.