Coronary artery dilation in Kawasaki disease

Kawasaki disease (KD) is an acute self -limited vasculitis of childhood that is characterised by fever, bilateral non-exudative conjunctivitis, erythema of lips and oral mucosa, changes in the extremities, rash and cervical lymphadaenopathy. Coronary artery dilation is the serious complication of Kawasaki disease.

Treatment should be started in time because it can reduce the inflammation and can prevent further disease progression especially the coronary artery dilation.

Laboratory tests typically reveal normal or elevated white blood cell count with neutrophil predominance and elevated acute phase reactants such as C-reactive protein and erythrocyte sedimentation rate during the acute phase.

Abnormal dilation of coronary arteries (the blood vessels which are supplying to heart) is detected by echocardiography. The presence of coronary artery abnormalities is considered a specific criterion supportive of the diagnosis of KD, particularly of those patients who do not meet the full clinical criteria for a diagnosis of complete KD.

The goal of therapy in the acute phase is to reduce inflammation and arterial damage and to prevent the thrombosis in those with coronary artery abnormalities.

                Patients with KD should be treated with high dose intravenous immunoglobulin (IVIG) within 10 days of illness onset but as soon as possible after diagnosis.

                It is reasonable to administer IVIG to children presenting after 10th day of illness if they have persistent fever without other explanation or coronary artery abnormalities together with ongoing systemic inflammation.

                Administration of moderate to high dose of acetylsalicylic acid is reasonable until the patient is afebrile, although there is no evidence that it reduces coronary artery aneurysm.

During acute phase of illness aspirin is administered. Aspirin is continued after the child has been afebrile for 48 to 72 hours. When high dose aspirin is discontinued, low dose is begun and continued until the patient has no evidence of coronary changes by 6-8 weeks after onset of illness.

Complications of coronary artery aneurysms can be rupture of coronary artery aneurysm which is rare. Most serious complications during the acute illness is thrombotic occlusion of coronary artery aneurysm.

Measles and varicella immunisation should be deferred for 11 months after a child receives high dose IVIG. A child in whom the risk of exposure to measles is high, however, may be vaccinated earlier and then be reimmunised ≥ 11 months after IVIG administration if the child has an inadequate serological response.

Follow up and duration of treatment of coronary arterial aneurysm in Kawasaki disease depends on the severity of the disease. Timely treatment can prevent the serious complication like coronary artery embolism and rupture. Awareness about the disease and complication is very important in that case.

The writer is a Consultant Paediatric Cardiologist at Apollo Hospitals, Dhaka.

Email: nazrintahera71@gmail.com