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Tyson M, Mustafa A, Venugopal P, Whitehead B, Anderson B, Mattke AC. Neonatal Kawasaki syndrome presenting as out of hospital cardiac arrest rescued by extracorporeal cardiopulmonary resuscitation. Perfusion 2019; 35:86-88. [PMID: 31074321 DOI: 10.1177/0267659119847438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 7-week-old girl presented in severe shock to a local emergency department. During transfer to the quaternary pediatric hospital, the child had a cardiac arrest and cardiopulmonary resuscitation was commenced en route. Upon arrival to the pediatric intensive care unit, extracorporeal life support was initiated via trans-sternal cannulation. Chest CT performed after extracorporeal life support cannulation, demonstrated widespread aneurysms and a diagnosis of Kawasaki disease was made. Immunomodulatory therapy with immunoglobulin and glucocorticoid medication was commenced and the child was separated from extracorporeal life support after 48 hours. Our case highlights both an unusual presentation of Kawasaki disease and the role extracorporeal cardiopulmonary resuscitation can play in the treatment of this disease. It describes the youngest reported patient in the literature with Kawasaki disease rescued by extracorporeal cardiopulmonary resuscitation and highlights how extracorporeal life support therapy can facilitate appropriate investigations to resolve diagnostic uncertainty and treat the underlying condition.
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Affiliation(s)
- Marguerite Tyson
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Ala Mustafa
- Queensland Paediatric Cardiac Service, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Prem Venugopal
- Department of Cardiothoracic Surgery, Queensland Children's Hospital, South Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Paediatric Critical Care Research Group, Queensland Children's Hospital, South Brisbane, QLD, Australia.,Queensland Paediatric Cardiac Research Group, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Ben Whitehead
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Rheumatology, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Ben Anderson
- Queensland Paediatric Cardiac Service, Queensland Children's Hospital, South Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Paediatric Critical Care Research Group, Queensland Children's Hospital, South Brisbane, QLD, Australia.,Queensland Paediatric Cardiac Research Group, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Adrian Christian Mattke
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Paediatric Critical Care Research Group, Queensland Children's Hospital, South Brisbane, QLD, Australia.,Queensland Paediatric Cardiac Research Group, Queensland Children's Hospital, South Brisbane, QLD, Australia
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Brahn E, Lehman TJ, Peacock DJ, Tang C, Banquerigo ML. Suppression of coronary vasculitis in a murine model of Kawasaki disease using an angiogenesis inhibitor. Clin Immunol 1999; 90:147-51. [PMID: 9884364 DOI: 10.1006/clim.1998.4645] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Coronary arteritis can be induced in C57BL/6 mice with a single intraperitoneal (ip) injection of Lactobacillus casei cell fragments. Histologic sections resemble the vasculitis and aneurysms observed in the medium-sized coronary arteries of children with Kawasaki disease. Since endothelial cells could play an important role in the development of vasculitis, a recently described angiogenesis inhibitor that is not an immunosuppressive agent, AGM-1470 (derived from Aspergillus fumigatus), was used to evaluate its therapeutic potential in this model. A total of 32 mice were administered 0.5 mg of sterile L. casei preparation ip on day 0 and randomized to either a treatment (AGM-1470, 27mg/kg sc alternate days) or a control (vehicle only) protocol. Hearts were harvested on day 14 (early disease) or at the end of the study on day 28 (established disease). Histologic sections were scored blindly for vasculitis. Day 14 sections from both protocols manifested only minimal disease, indicating that the vasculitis had not yet matured. By day 28, the AGM-1470 group had significantly less coronary vasculitis than the control group (0.7 vs 2.6, p < 0.005, respectively). These studies suggest that endothelial cells may play an active role in this pathologic process and that angiogenesis inhibitors, such as AGM-1470, could be useful tools for the treatment and understanding of vasculitis.
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Affiliation(s)
- E Brahn
- UCLA School of Medicine, Los Angeles, California, 90095-1670, USA
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