The patient, 42-year-old male, was suffered from Kawasaki disease (KD) at 4 month of age and left with giant left coronary artery aneurysm (CAA) and occluded giant right CAA. When he visited us at 40 years of age after long interval, a multi-detector X-ray computed tomography revealed persistent giant CAA with 12 mm in diameter at segment 6 with low density area inside of it, stenosis distal to this CAA, persistent giant CAA with 12 mm in diameter at segment 11, and total occlusion of right coronary artery orifice with recanalization. Positron emission tomography using fluorodexoy glucose (FDG-PET) with co-registration of x-ray computed tomography showed significant FDG uptake around the left coronary orifice of the aortic wall and extending to the proximal left CAA wall with 1.48 of target-to-background ratio, indicating persistent inflammation. He has 2 risk factors of atherosclerosis, dyslipidemia and a history of smoking and, since then he has been placed on 2 mg of oral pitavastatin. With the treatment, his LDL-cholesterol has decreased (105 at baseline vs. 74 mg/dL on treatment) though HDL-cholesterol did not change significantly (31 at baseline vs. 30 mg/dl on treatment). FDG-PET after 2 years of treatment indeed showed alleviation of coronary inflammation with significantly smaller area and lower uptake of FDG on the coronary wall with 1.28 of target-to-background ratio. This case indicates that statin can alleviate persistent coronary artery inflammation long after KD and FDG-PET can be a useful monitoring tool of this process.
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Oct 24, 2017
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