Kawasaki disease, delayed referral as a cause of coronary artery affection

Abstract

Kawasaki disease (KD), an acute febrile vasculitis, is the most common cause of acquired heart disease in infants and young children. However, the diagnosis of infantile KD can be difficult or delayed due to vague clinical manifestations. This current study aimed to review patients referred to pediatric cardiology at PSCC-Qassim with a diagnosis or suspicion of Kaawasaki disease. Retospectively review of the database as well as patients files. During the period from August till 2009 August 2012, 23 patients were referred to PSCC-Q, with a mean F/U period of 32 months. The mean age of presentation ±SD was 32 ± 28 months (range 5–96 months). The timing of referral was ranging from 2 to 30 days from the onset of fever. 13 patients were having complete criteria for Kawasaki on presentation, 8 of them developed cardiac affection. Out of the 22 patients referred 12 had cardiac abnormality in the form of mitral insufficiency in 2, aortic root dilatation in one and coronary artery involvement in 6 patients. All patients except one received IgG at a mean time from onset of fever of 10 ± 6 days (range 5–30 days). Two patients required a second dose of IgG after 48 h from the first dose. Initial echo was normal in 13. The most commonly affected coronary artery was the LAD. ECG was abnormal in one. Comparison between the groups with and without cardiac affection was done. There was a difference in all variables but did not reach a statistically significant value. A significant number of patients with complete as well as incomplete Kawasaki had cardiac involvement especially coronary atery affection. Delay in the referral as well as in the administration of IgG may lead to developement of coronary artery involvement.