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[Late recognition of Kawasaki disease--difficulties in diagnosis]
Joanna Kohut1, Ewa Gołba, Grazyna Giec-Fuglewicz
1Z Katedry i Kliniki Kardiologii Dzieciecej.
Insights
A child with Down syndrome developed Kawasaki disease and complete heart block after surgery. Early treatment with immunoglobulins and aspirin is crucial for preventing coronary artery aneurysms.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Genetics
Background:
- A 4-year-old girl with Down syndrome underwent surgery for common atrioventricular canal and patent ductus arteriosus.
- A year post-surgery, she developed intermittent complete atrioventricular block, initially deemed non-significant.
Observation:
- Kawasaki disease was diagnosed based on characteristic symptoms including fever, conjunctivitis, and skin changes.
- Electrocardiogram (ECG) revealed complete atrioventricular block with significant bradycardia.
- Echocardiography (ECHO) identified coronary artery aneurysms.
Findings:
- Standard Kawasaki disease treatment (immunoglobulins, aspirin) was initiated.
- Orciprenaline was administered for the atrioventricular block.
- A pacemaker was implanted due to persistent bradycardia.
Implications:
- Literature review indicates immunoglobulins and aspirin reduce coronary aneurysm risk.
- Biochemical and physical signs cannot reliably predict aneurysm risk in Kawasaki disease patients.
- Universal treatment with immunoglobulins is recommended for all affected patients, and a procedural algorithm for coronary aneurysms was presented.
Abstract:
Authors describe the case of 4 years old girl with Down syndrome, who was operated due to common atrio-ventricular canal and persistent Botalli's duct. Intermittent total atrio-ventricular block (without significant bradycardia) has been observed one year later and considered as a late postoperative block requiring no treatment. Kawasaki disease was diagnosed because of the presence of 4 out of 6 leading symptoms appearing in typical chronology (fever, mouth and throat inflammation, conjunctivitis, erythema with subsequent desquamation of skin on palms and feet). ECG revealed total atrio-ventricular block, however with significant bradycardia. ECHO showed aneurysms in both coronary arteries. Standard treatment of Kawasaki disease was administered (immunoglobulins, acetylsalicylic acid) and orciprenalin due to described cardiac block. Pacemaker was implanted because of bradycardia. The literature review showed that the treatment with immunoglobulins and aspirin can reduce the risk of coronary aneurysms development. On the other hand, identification of patients at risk coronary aneurysms development is not possible on the ground of biochemical blood analysis and physical signs. Thus, all the patients stricken should be treated with described above costly drugs (immunoglobulins). Finally, the algorithm of procedures in patients with coronary aneurysms was presented.
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