Acute myocardial infarction in an adolescent following recurrent Kikuchi-Fujimoto disease

Area of Science:

• Pediatrics
• Cardiology
• Rheumatology

Background:

• Kawasaki disease-like fever (KFD) is typically a benign, self-limiting illness.
• Complications are rare, but recurrent or atypical KFD may pose long-term risks.
• The potential for KFD to cause chronic vascular inflammation is not well-established.

Purpose of the Study:

• To report the first pediatric case of acute myocardial infarction (AMI) potentially linked to recurrent KFD.
• To highlight the possibility of long-term vascular consequences following KFD.

Main Methods:

• Case report of an early adolescent male.
• Detailed clinical history including recurrent episodes of fever and lymphadenopathy.
• Diagnostic imaging: Positron Emission Tomography-CT (PET-CT) for lymphadenopathy.
• Cardiac catheterization to assess coronary artery status.
• Percutaneous coronary intervention (PCI) for management of coronary stenoses.

Main Results:

• The patient experienced three episodes of KFD characterized by fever and painful lymphadenopathy.
• PET-CT during the third episode showed widespread lymphadenopathy, including mediastinal involvement.
• Fifteen months after the third KFD episode, the patient presented with acute chest and shoulder pain.
• Cardiac catheterization revealed severe coronary artery stenoses, necessitating PCI.

Conclusions:

• This case suggests a potential association between recurrent KFD and the development of AMI in a pediatric patient.
• Chronic or subclinical inflammation secondary to KFD may contribute to early-onset atherosclerosis.
• Recurrent or atypical KFD warrants consideration for potential long-term vascular sequelae.