Multisystem Imaging Manifestations of Kawasaki Disease

Progressive coronary aneurysms in Kawasaki disease: A case report and long-term follow-up

Kawasaki disease (KD) is a vasculitis that primarily affects children under 5 years of age with coronary artery aneurysms being a significant complication that can lead to long-term cardiovascular risks such as thrombosis and stenosis. We report the case of a 13-year-old boy who was diagnosed with KD after presenting with fever, skin lesions, and conjunctivitis. Cardiac imaging revealed aneurysms of the intraventricular artery, the circumflex artery, and the right coronary artery. Despite initial treatment with intravenous immunoglobulin, aspirin, low molecular weight heparin, and subsequent acenocoumarol therapy, the patient experienced progressive thrombosis of the intraventricular artery aneurysm over 3 years. Investigations revealed a hypercoagulable state due to hyperactive Von Willebrand factor, prompting treatment adjustments that resulted in gradual improvement of the thrombosis. This case underscores the critical need for early imaging, timely diagnosis, and long-term monitoring of KD patients, as coronary aneurysms may persist or progress despite prompt therapy. Rigorous follow-up, tailored anticoagulation strategies, and regular imaging are essential to minimize the risk of life-threatening cardiovascular complications.

Urgent and emergent pediatric cardiovascular imaging

The need for urgent or emergent cardiovascular imaging in children is rare when compared to adults. Patients may present from the neonatal period up to adolescence, and may require imaging for both traumatic and non-traumatic causes. In children, coronary pathology is rarely the cause of an emergency unlike in adults where it is the main cause. Radiology, including chest radiography and computed tomography in conjunction with echocardiography, often plays the most important role in the acute management of these patients. Magnetic resonance imaging can occasionally be useful and may be suitable in more subacute cases. Radiologists' knowledge of how to manage and interpret these acute conditions including knowing which imaging technique to use is fundamental to appropriate care. In this review, we will concentrate on the most common cardiovascular emergencies in the thoracic region, including thoracic traumatic and non-traumatic emergencies and pulmonary vascular emergencies, as well as acute clinical disorders as a consequence of primary and postoperative congenital heart disease. This review will cover situations where cardiovascular imaging may be acutely needed, and not strictly emergencies only. Imaging recommendations will be discussed according to the different clinical presentations and underlying pathology.

Maximum Diameter of Ileocecal Lymph Nodes Measured Using Abdominal Ultrasonography Allows for the Discrimination of Yersinia pseudotuberculosis Infection from Kawasaki Disease

BACKGROUND

This study aimed to determine whether the maximum diameter of ileocecal lymph nodes measured using abdominal ultrasonography is useful for differentiating Yersinia pseudotuberculosis infection from Kawasaki disease in the acute phase. The optimal maximum diameter cutoff of the ileocecal lymph nodes was also explored to optimize differentiation between these 2 diseases.

METHODS

We included pediatric patients <15 years old who met the diagnostic criteria for Kawasaki disease. Stool culture testing, loop-mediated isothermal amplification of stool specimens, and serological diagnosis were performed to confirm the presence or absence of Y. pseudotuberculosis infection.

RESULTS

Of the 122 patients included in the analysis, 17 were confirmed to have Y. pseudotuberculosis infection and 105 were not. The age (in months), white blood cell count, C-reactive protein level, prediction score (risk score) for nonresponse to intravenous immunoglobulin, and number of intravenous immunoglobulin doses did not differ significantly between the Y. pseudotuberculosis -positive and -negative groups. The maximum diameter of ileocecal lymph nodes was 6.0 (5.5-9.5) mm in the Y. pseudotuberculosis -positive group and 3.0 (2.5-3.8) mm in the Y. pseudotuberculosis -negative group (numbers presented as median, interquartile range), with a significantly larger diameter in the Y. pseudotuberculosis -positive group ( P < 0.01, Mann-Whitney U test), suggesting potency of ultrasonography.

CONCLUSION

In patients meeting the diagnostic criteria for Kawasaki disease, the possibility of Y. pseudotuberculosis infection is significantly higher if the maximum ileocecal lymph node diameter ≥5.1 mm. Its sensitivity and specificity being 100%, and 89.5%, respectively.

Beyond the Atypical: Gastrointestinal Manifestations in Kawasaki Disease

Kawasaki disease (KD) is an acute vasculitis mainly seen in children, with a specific risk for coronary artery involvement. Atypical symptoms can sometimes result in missed diagnoses, delaying necessary treatment and increasing the chances of serious cardiovascular complications. We report a case of a six-month-old previously healthy girl who had not been vaccinated. She presented with high fever, vomiting, and diarrhea for two weeks. The initial treatment for a suspected upper respiratory infection and later gastrointestinal issues created a diagnostic challenge. After many tests and scans over several weeks, a clear diagnosis was made only when an echocardiogram showed dilated coronary arteries and a dilated aortic root. She was then diagnosed with atypical KD and was given high doses of aspirin and intravenous immunoglobulins, resulting in substantial improvement in her condition. This case points out the difficulty in diagnosing KD in very young children, particularly when typical signs are missing. The delayed identification of KD led to serious complications, highlighting the importance of greater awareness among healthcare workers about atypical symptoms in infants. Quick action is vital to reduce the risk of severe cardiovascular consequences and to avoid delaying necessary treatment.

Late onset Kawasaki disease with multiple coronary arterial aneurysms: A case report

Kawasaki disease is an acute, self-limiting, systemic vasculitis of small and medium-sized arteries. It predominantly occurs in children under 4 years of age, though rarely older children can also be affected. This disease is the leading cause of acquired heart disease in children, with coronary aneurysms being a hallmark finding. The risk of coronary complications necessitates regular monitoring and possible preventative treatment with thromboprophylaxis. Here we discuss a rare case of a 10-year-old boy who exhibited typical symptoms of Kawasaki disease and was found to have multiple coronary artery aneurysms through diagnostic imaging.

Incomplete Kawasaki Disease in an Adult Complicated by Stroke

Kawasaki disease (KD) is a systemic vasculitis with an unclear origin primarily affecting young children. The sole difference between complete and incomplete KD upon presentation is the number of signs and symptoms. There is a concerning case of a 50-year-old male with incomplete KD who has additionally presented with a stroke. Cases of KD are uncommon in adults but well-known in children. Ischemic stroke is quite rare in people with incomplete KD. This appears to be the first documented case of incomplete KD linked to a stroke in an adult. Because of the potentially life-threatening consequences associated with KD, healthcare professionals must take a multidisciplinary approach when assessing and managing such patients.

Inhibition of PDGFRβ alleviates endothelial cell apoptotic injury caused by DRP-1 overexpression and mitochondria fusion failure after mitophagy

Kawasaki disease (KD), described as "mucocutaneous lymph node syndrome", affects infants and toddlers. Patients with KD suffer from an inflammatory cascade leading to vasculitis with a predilection for coronary arteries. While the symptoms and pathogenesis of KD have received more and more attention, the precise mechanisms are still debated. Researches show that endothelial dysfunction process in KD leads to arterial damage and affect clinical outcome. In this study, we constructed a Candida albicans water soluble fraction (CAWS)-induced KD murine model and penetrated investigating the mechanisms behind endothelial dysfunction. CAWS-induced mice presented remarkably elevated vascular endothelial cell growth factor (VEGF) levels. Abundant expression of VEGF was documented in all vessels that showed edema from acute KD. It has been reported that Platelet-derived growth factor (PDGF) co-expression normalizes VEGF-induced aberrant angiogenesis. Hyperexpression of PDGFRβ was induced in the thickened medial layer and vascular endothelium of KD mice. Masitinib (Mas) is an oral tyrosine kinase inhibitor of numerous targets, which can selectively target PDGFR signaling. We set out to explore whether Mas could regulate coronary pathology in KD. Mas administration significantly reduced the VEGF-induced endothelial cells migration. NOX4 was activated in vascular endothelial cells to produce more ROS. Mitochondrial dysregulated fission and mitophagy caused by DRP-1 overexpression precipitated the arterial endothelial cells injury. Here, mitophagy seemed to work as the driving force of DRP-1/Bak/BNIP3-dependent endothelial cells apoptosis. In summary, how mitophagy is regulated by DRP-1 under pathologic status is critical and complex, which may contribute to the development of specific therapeutic interventions in cardiovascular diseases patients, for example Masatinib, the inhibitor of PDGFRβ. FACTS AND QUESTIONS: Kawasaki disease causing systemic vasculitis, affects infants and toddlers. Coronary artery injury remains the major causes of morbidity and mortality. DRP-1 overexpression induces DRP-1/Bak/BNIP3-dependent endothelial cells apoptosis. PDGFRβ was high-expressed in the thickened medial layer of CAWS-induced KD mice. Inhibition of PDGFRβ signaling alleviates arterial endothelial cells injury.

Kawasaki disease with peritonsillar abscess as the first symptom: A case report

BACKGROUND

Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is an acute, self-limiting vasculitis of unknown aetiology that mainly involves the medium and small arteries and can lead to serious cardiovascular complications, with a 25% incidence of coronary artery aneurysms. Periton-Sillar abscesses are a rare symptom of KD and is easily misdiagnosed at its early stages.

CASE SUMMARY

A 5-year-old boy who presented to a community hospital with a 3-d fever, difficulty in opening his mouth, and neck pain and was originally treated for throat infection without improvement. On the basis of laboratory tests, ultrasound of submandibular and superficial lymph nodes and computed tomography of the neck, the clinician diagnosed the periamygdala abscess and sepsis that did not resolve after antibiotic therapy. On the fifth day of admission, the child developed conjunctival congestion, prune tongue, perianal congestion and desquamation, and slightly stiff and swollen bunions on both feet. A diagnosis of KD was reached with complete remission after intravenous immunoglobulin treatment.

CONCLUSION

Children with neck pain, lymph node enlargement, or airway obstruction as the main manifestations are poorly treated with intravenous broad-spectrum antibiotics. Clinicians should not rush invasive operations such as neck puncture, incision, and drainage and should be alert for KD when it cannot be explained by deep neck space infection and early treatment with aspirin combined with gammaglobulin.

Kawasaki disease with peritonsillar abscess as the first symptom: A case report

BACKGROUND

Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is an acute, self-limiting vasculitis of unknown aetiology that mainly involves the medium and small arteries and can lead to serious cardiovascular complications, with a 25% incidence of coronary artery aneurysms. Periton–Sillar abscesses are a rare symptom of KD and is easily misdiagnosed at its early stages.

CASE SUMMARY

A 5-year-old boy who presented to a community hospital with a 3-d fever, difficulty in opening his mouth, and neck pain and was originally treated for throat infection without improvement. On the basis of laboratory tests, ultrasound of submandibular and superficial lymph nodes and computed tomography of the neck, the clinician diagnosed the periamygdala abscess and sepsis that did not resolve after antibiotic therapy. On the fifth day of admission, the child developed conjunctival congestion, prune tongue, perianal congestion and desquamation, and slightly stiff and swollen bunions on both feet. A diagnosis of KD was reached with complete remission after intravenous immunoglobulin treatment.

CONCLUSION

Children with neck pain, lymph node enlargement, or airway obstruction as the main manifestations are poorly treated with intravenous broad-spectrum antibiotics. Clinicians should not rush invasive operations such as neck puncture, incision, and drainage and should be alert for KD when it cannot be explained by deep neck space infection and early treatment with aspirin combined with gammaglobulin.