Abstract 136: A Case of Complex Congenital Heart Disease with Postoperative Complications of Impaired Consciousness and Several Arrhythmias due to Encephalitis in the Acute Stage of Kawasaki Disease

Abstract

Background: In addition to muscular and medium arteries, Kawasaki disease causes inflammation in nerves and the myocardium. However, arrhythmia severe enough to be problematic is rare. Patient: At age 1 day, the patient was in a state of shock and was diagnosed with Taussig-Bing anomaly and aortic arch coarctation. At age 4 days, he underwent aortic arch reconstruction and pulmonary arterial banding. At age 2 months, he underwent arterial switch operation and ventricular septal defect closure. No significant arrhythmias were observed. At age 5 years 6 months, he had a fever, and 5 days later, he developed rash, conjunctival hyperemia, and redness of the lips and fingertips. Kawasaki disease was diagnosed on day 7 after symptom onset. The patient presented with disorientation, so electroencephalography and magnetic resonance imaging were performed and revealed overall slow-wave activity and cerebral edema, respectively, indicating complicated encephalitis. Sinoatrial block and sinus arrest were also observed. The patient received ultrahigh-dose γ-globulin therapy and steroid pulse therapy for encephalitis. The fever resolved at a total γ-globulin dose of 4 g/kg. The other main Kawasaki disease symptoms also disappeared. By day 18, his consciousness completely recovered but the sinus arrest remained. On day 20, an atrial flutter developed from tachycardia that was treated with electric shocks. Sinus arrest at a maximum of 5.7 s was observed at that time, and bradycardia-tachycardia syndrome was suspected. On the same day, the sinus arrest improved gradually and largely disappeared 3 days later. The atrial flutter also disappeared. Discussion: Severe arrhythmia that requires treatment is rare in Kawasaki disease. Our patient underwent surgery for a complex cardiac anomaly. Thus, the requisites for arrhythmia were present when the Kawasaki disease caused myocardial inflammation, which is thought to cause severe symptoms.