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Transient heart failure in an adult with Kawasaki disease
Insights
Kawasaki disease, a condition typically affecting children, can cause temporary heart failure in adults. This case highlights the importance of considering Kawasaki disease in adults presenting with heart failure and fever, even without typical childhood symptoms.
Area of Science:
- Cardiology
- Rheumatology
- Pediatrics
Background:
- Kawasaki disease is a pediatric illness characterized by mucocutaneous lymph node syndrome.
- It is known for potential cardiovascular complications, primarily in children.
Observation:
- A 31-year-old woman presented with acute heart failure during the febrile phase of Kawasaki disease.
- Clinical manifestations included fever, conjunctivitis, strawberry tongue, lymphadenopathy, rash, and desquamation.
- Cardiac findings included tachycardia, hypotension, pulmonary rales, S3 gallop, and elevated cardiac enzymes.
Findings:
- The patient experienced transient heart failure with diffuse hypokinesia and reduced ejection fraction.
- Diagnostic imaging revealed signs of pulmonary edema and myocardial dysfunction.
- Coronary angiography showed no aneurysmal dilatation, indicating recovery from acute cardiac involvement.
Implications:
- Kawasaki disease is a rare but significant cause of adult myocardial dysfunction.
- Adult heart failure during acute febrile illness warrants consideration of Kawasaki disease, especially with mucocutaneous signs.
- Early recognition and management are crucial to prevent long-term cardiovascular sequelae.
Abstract:
Kawasaki disease is a mucocutaneous lymph node syndrome with important cardiovascular complications that usually afflicts young children. We describe a 31-year-old woman who developed transient heart failure during the acute phase of Kawasaki disease. The diagnosis was supported by the presence of all six criteria of the disease: fever, conjunctivitis, strawberry tongue, cervical lymphadenopathies, truncal exanthem, and periungual membranous desquamation. Related clinical and laboratory findings included heart failure, arthralgias, transverse nail grooves, thrombocytosis, and elevated serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), and bilirubin. Alternative diagnoses were excluded. During her acute febrile illness, the patient developed tachycardia, hypotension, pulmonary rales, S3 gallop, and hepatojugular reflux. The chest roentgenogram showed new Kerley A and B lines. A first-pass isotopic ventriculography showed diffuse hypokinesia and decreased ventricular ejection fractions; spontaneous recovery occurred after a few days. A coronarography performed two months later showed no aneurysmal dilatation. Kawasaki disease is a cause, albeit rare, of myocardial dysfunction in the adult human, and should be sought for actively in a patient with heart failure during the course of an acute febrile illness, associated with mucocutaneous changes.