Kawasaki disease or polyarteritis nodosa: coronary involvement, a diagnostic conundrum

Area of Science:

• Pediatric Rheumatology
• Vasculitis Research
• Cardiology

Background:

• Polyarteritis nodosa (PAN) is a medium-vessel vasculitis with multisystem involvement.
• Coronary artery aneurysms are characteristic of Kawasaki disease but rarely seen in PAN.
• Distinguishing between PAN and Kawasaki disease is vital due to differing treatment protocols and prognoses.

Purpose of the Study:

• To present two pediatric cases of PAN with coronary artery involvement that mimicked Kawasaki disease.
• To highlight the diagnostic challenges and key differentiating features between PAN and Kawasaki disease.
• To emphasize the importance of early and accurate diagnosis for optimal patient management.

Main Methods:

• Case report analysis of two pediatric patients.
• Review of clinical presentations, laboratory findings, and imaging studies (echocardiography, digital subtraction angiography).
• Comparison of diagnostic criteria and treatment approaches for PAN and Kawasaki disease.

Main Results:

• Two children presented with features suggestive of Kawasaki disease, including coronary aneurysms.
• Diagnostic workup revealed PAN involving coronary and other visceral arteries (celiac, renal).
• Digital subtraction angiography confirmed vasculitic changes consistent with PAN in both cases.

Conclusions:

• Coronary artery aneurysms, though rare, can be a presenting feature of childhood PAN.
• Accurate differentiation from Kawasaki disease is essential due to distinct therapeutic strategies and long-term outcomes.
• Clinical vigilance and appropriate imaging are crucial for diagnosing PAN presenting as Kawasaki disease.