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Four cases of Kawasaki syndrome complicated with myocarditis

Hideki Yoshikawa1, Yuichi Nomura, Kiminori Masuda

  • 1Division of Pediatrics, Graduate School of Medical and Dental sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan. yosshii@po2.synapse.ne.jp

Circulation Journal : Official Journal of the Japanese Circulation Society
|January 26, 2006
PubMed

Insights

Kawasaki syndrome (KS) myocarditis can cause severe left ventricular dysfunction, particularly in older children. Monitor cardiac function closely, as inflammation may worsen after intravenous immunoglobulin (IVIG) treatment.

Area of Science:

  • Pediatric Cardiology
  • Infectious Diseases
  • Inflammatory Conditions

Background:

  • Myocarditis is a common complication during the acute phase of Kawasaki syndrome (KS).
  • Severe cases of KS-associated myocarditis requiring intensive care have been reported.
  • Left ventricular dysfunction (LVD) is a significant concern in these patients.

Observation:

  • Four pediatric cases of KS-associated myocarditis requiring catecholamine treatment for LVD are presented.
  • Two patients had concurrent encephalopathy, and all four developed coronary artery abnormalities.
  • One case showed LVD due to inflammation before intravenous immunoglobulin (IVIG) administration.

Findings:

  • Three patients initially had normal ejection fractions but experienced decreased function (42-51%) post-IVIG.
  • Elevated C-reactive protein levels were observed after IVIG in these patients, indicating worsening inflammation.
  • These findings suggest a link between myocarditis in KS and severe or exacerbated inflammation, even after initial treatment.

Implications:

  • Continuous cardiac function monitoring is crucial for KS patients, especially older children.
  • Particular attention should be paid to patients experiencing worsening inflammation post-IVIG.
  • Early recognition and management of LVD are vital for improving outcomes in severe KS cases.
Abstract

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