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Atypical Kawasaki disease: A patient with coronary, brain, and internal mammary arteritis

Azumi Hamasaki1, Tetsuro Uchida1, Yoshinori Kuroda1

  • 1Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan.

Journal of Cardiac Surgery
|March 23, 2019
PubMed

Insights

This case study details atypical Kawasaki disease (KD) in a 25-year-old man, presenting with systemic arteritis affecting coronary, cerebral, and internal mammary arteries (IMAs). It highlights the first reported instance of KD involving the IMA.

Area of Science:

  • Cardiovascular Medicine
  • Rheumatology
  • Pediatric Cardiology

Background:

  • Kawasaki disease (KD) typically affects children, causing inflammation in blood vessel walls.
  • Systemic arteritis, a rare manifestation, can involve various arteries beyond the coronary arteries.
  • Atypical presentations of KD require careful consideration for accurate diagnosis and management.

Observation:

  • A 25-year-old male presented with angina pectoris, indicative of coronary artery disease.
  • Coronary angiography revealed coronary artery aneurysms and triple-vessel disease.
  • Cerebral angiography identified multiple small saccular aneurysms in the vertebral and posterior inferior cerebellar arteries.

Findings:

  • The patient exhibited systemic arteritis involving coronary, cerebral, and internal mammary arteries (IMAs).
  • Off-pump coronary artery bypass (OPCAB) grafting was performed, but bilateral IMAs were found non-patent due to adhesions.
  • This case represents the first documented instance of Kawasaki disease affecting the IMAs.

Implications:

  • This report expands the understanding of Kawasaki disease's potential vascular targets, including IMAs.
  • Early recognition of atypical KD manifestations is crucial for timely intervention and preventing severe vascular complications.
  • Further research into adult-onset KD and its diverse arterial involvements is warranted.

Keywords:
Kawasaki diseasecoronary artery aneurysminternal mammary artery

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