scholarly journals 3,4-Methylenedioxymethamphetamine (MDMA, Ecstasy) Intoxication in a Young Adult with Giant Coronary Aneurysms from Kawasaki Disease

2018 ◽  
Vol 8 (3) ◽  
pp. 752-762 ◽  
Author(s):  
Renee Eigsti ◽  
Dennis J. Firchau ◽  
Marcus B. Nashelsky
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Left Ventricle ◽  
Coronary Arteries ◽  
Coronary Artery Spasm ◽  
Artery Aneurysm ◽  
Unknown Etiology ◽  
Stress Tests ◽  
Coronary Aneurysms ◽  
Increased Risk

Kawasaki disease is an acute vasculitis of unknown etiology that usually occurs in children less than five years old. Coronary artery aneurysm due to arteritis is the most common cardiac complication. Chronic aneurysms are associated with an increased risk of developing luminal thrombosis and ischemic myocardial injury. We present a case of an 18-year-old male with a history of Kawasaki disease complicated by chronic giant aneurysms of the right and left coronary arteries. Serial echocardiographic studies and treadmill electrocardiogram stress tests as recent as 1.5 years before death revealed excellent cardiac function by clinical criteria. The decedent sustained a witnessed collapse after ingesting 3,4-methylenedioxymethamphetamine (MDMA) and ethanol. He was pronounced dead in the emergency department after unsuccessful resuscitative efforts. Autopsy revealed large aneurysms of the three main epicardial coronary arteries with extensive foci of severe stenosis by intimal fibrosis and organizing thrombus. Microscopic examination revealed multifocal severe myocyte hypertrophy. There were remote microinfarcts in the anterior and posterior aspects of the left ventricle and a recent, healing microinfarct in the posterior aspect of the left ventricle. Toxicology examination of postmortem femoral blood revealed MDMA, ethanol, and amiodarone. This case illustrates the residual, lasting effects of cardiac disease due to Kawasaki disease and a potential complication in the setting of use of an illicit stimulant, MDMA, an amphetamine derivative that produces sympathetic activation and cardiovascular effects including tachycardia, vasoconstriction, dysrhythmias, and coronary artery spasm. Kawasaki disease-related abnormalities of the heart likely resulted in a lower threshold for developing a fatal cardiac dysrhythmia under the circumstance of stimulant use.

Usefulness and safety of anakinra in refractory Kawasaki disease complicated by coronary artery aneurysm

2018 ◽  
Vol 28 (5) ◽  
pp. 739-742 ◽  
Author(s):  
Marie-Paule Guillaume ◽  
Héloïse Reumaux ◽  
François Dubos
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Coronary Arteries ◽  
Coronary Artery Aneurysm ◽  
Artery Aneurysm ◽  
Intravenous Immunoglobulins ◽  
Unknown Aetiology ◽  
Partial Regression ◽  
Coronary Aneurysms

AbstractKawasaki disease is an acute self-limited vasculitis of unknown aetiology. The prognosis depends mainly on coronary damage. There is no consensus regarding optimal adjunctive therapeutics for refractory forms to treatment by intravenous immunoglobulins and corticosteroids. We report the case of an 18-month-old infant with refractory Kawasaki disease complicated by diffuse aneurysms of coronary arteries and successfully treated by anakinra with partial regression of coronary aneurysms

Abstract 34: Genome-wide Association Study Identified New Susceptibility Loci To Coronary Artery Aneurysm-related In Kawasaki Disease

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Kyu Yeun Kim ◽  
Mo Kyung Jung ◽  
Yoon-Sun Bae ◽  
Woohyuk Ji ◽  
Dongjik Shin ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Association Study ◽  
Genome Wide Association Study ◽  
Coronary Artery Aneurysm ◽  
Artery Aneurysm ◽  
Genome Wide Association ◽  
Korean Children ◽  
Genome Wide ◽  
Increased Risk

Kawasaki disease (KD) is an acute systemic vasculitis syndrome that predominantly affects children younger than 5 years of age, and may causes serious, sometimes life-threatening, cardiac sequela associated with coronary artery aneurysm (CAA). To identify genetic variants that confers a highly increased risk of coronary artery aneurysm-related in Kawasaki disease. In this study, we carried out genome-wide association study (GWAS) in a Korean children population including 102 CAA-related KD cases and 126 controls. Fifteen genetic loci were found to be significantly correlated with KD risk (P<1.0X10(-7)). Our case-control study revealed that rs4236089 C allele in chloride intracellular channel 5 (CLIC5) gene at 6p21.1 was significantly associated with KD patients with CAA (odds ratio (OR)=4.6, P=7.53X10(-7)). These findings suggest that the CLIC5 gene may play a crucial role in CAA development pathway of KD.

Kawasaki Disease in a Patient With Williams Syndrome

2018 ◽  
Vol 11 (4) ◽  
pp. NP144-NP147
Author(s):  
Aleisha M. Nabower ◽  
Lois J. Starr ◽  
Jonathan Cramer
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Williams Syndrome ◽  
Coronary Arteries ◽  
Incomplete Kawasaki Disease ◽  
Cardiac Anomalies ◽  
Coronary Artery Dilatation ◽  
Coronary Aneurysms

Kawasaki disease can be difficult to diagnose in infants, putting them at higher risk for developing coronary artery dilatation. It can be even more difficult to diagnose in the setting of preexisting cardiac anomalies such as those found in Williams syndrome. We present a case of a three-month-old male with Williams syndrome with rapidly developing giant coronary aneurysms due to Kawasaki disease. This case demonstrates the importance of repeat echocardiography in diagnosing incomplete Kawasaki disease in infants. We speculate that elastin changes, as present in Williams syndrome, may put affected children at higher risk for development of giant coronary arteries should they acquire Kawasaki disease.

Abstract 103: Incomplete Kawasaki Disease - Patients With ≦ 5 Days Of Fever Successfully Treated By Antibiotics But Left With Coronary Aneurysms -

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Kenji Suda ◽  
Hiroshi Nishino ◽  
Yoshiyuki Kudo ◽  
Hironaga Yoshimoto ◽  
Shintaro Kishimoto ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Case Series ◽  
Artery Aneurysm ◽  
Ivig Treatment ◽  
Incomplete Kawasaki Disease ◽  
Antithrombotic Treatment ◽  
Coronary Aneurysms ◽  
Appropriate Treatment ◽  
Echocardiographic Examination

Objective: We report four patients with incomplete Kawasaki disease (KD) successfully treated by antibiotics without intravenous immunoglobulin (IVIG) treatment with ≦ 5 days of fever but left with coronary artery lesion. Result: The patients were 2 babies and 2 young children age ranged from 2 months to 2 years old and 9 months. They showed fever and other signs of KD, but did not fulfill diagnostic criteria. The numbers of symptoms compatible with KD were 2 or 3 and included conjunctival injection, oral or lip injection, and eruption. Within 5 days, they became afebrile by antibiotics without IVIG treatment. However, they were noted to have coronary artery aneurysm (CAA) on day from 7 to 33 of illness. All patients had been placed on antithrombotic treatment including aspirin or aspirin plus warfarin and, fortunately, showed regression of CAA within 2 years. Conclusions: This case series indicates that there are patients with incomplete KD successfully treated by antibiotics without IVIG but left with CAA. These cases must be underdiagnosed if intentional echocardiographic examination are scheduled and might be left without appropriate treatment, antithrombotic treatment. Further collection of data of these patients is indispensable.

scholarly journals Recurrent Kawasaki Disease: A Case Report of Three Separate Episodes at >4-Year Intervals

Children ◽  
2018 ◽  
Vol 5 (11) ◽  
pp. 155 ◽  
Author(s):  
Nikita Goswami ◽  
Katherine Marzan ◽  
Elizabeth De Oliveira ◽  
Sharon Wagner-Lees ◽  
Jacqueline Szmuszkovicz
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Systemic Vasculitis ◽  
High Dose ◽  
Z Score ◽  
Coronary Aneurysms ◽  
Increased Risk ◽  
The Right ◽  
Work Up ◽  
High Dose Aspirin

Kawasaki disease (KD) is a self-limited systemic vasculitis, most often occurring in children 1–5 years old. It has a 2% recurrence rate and is associated with coronary aneurysms (CA), which can develop within two weeks of onset. A 25% increased risk is noted in patients who are recalcitrant to treatment. We describe a patient with recurrence of KD three times, approximately four years apart. A 10-year-old female with two previous episodes of KD, at 11 months and five years of age), in which she met five out of five criteria for KD and had no coronary involvement, presented with 15 days of fever, conjunctivitis and mucocutaneous changes. Infectious work-up was negative, and she was diagnosed with incomplete KD meeting three out of five criteria. An echocardiogram (ECHO) on day 12 revealed dilation of the right coronary artery (RCA) and left coronary artery (LCA). Treatment with intravenous immunoglobulin (IVIG) and high-dose aspirin was started at an outside hospital. After transfer, serial ECHOs showed evolving coronary aneurysms, left anterior descending (LAD) z-score + 8.2 and RCA z-score + 4.0. She received 10 mg/kg infliximab (day 18) and began clopidogrel. A cardiac MRI (day 20) demonstrated progression of the LAD aneurysm, with a z-score + 13, and warfarin was started. To our knowledge, this is the first report of recurrent KD occurring three times at ~5 year intervals.

scholarly journals The Relationship Between TNF-Like Protein 1A and Coronary Artery Aneurysms in Children With Kawasaki Disease

2021 ◽  
Author(s):  
jing zhang ◽  
Haobo Weng ◽  
Qiongfei Pei ◽  
Penghui Yang ◽  
Wentao Fan ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Development Process ◽  
Systemic Vasculitis ◽  
Artery Aneurysm ◽  
Unknown Etiology ◽  
Coronary Artery Aneurysms ◽  
Tnf Superfamily ◽  
The Relationship ◽  
Necrosis Factor

Abstract Background: Kawasaki disease (KD) is an acute, systemic vasculitis of unknown etiology that occurs predominantly in infants and children, and the most crucial complication of KD is coronary artery aneurysm (CAA). Tumor necrosis factor (TNF)-like protein 1A (TL1A) is a member of the TNF superfamily, which possesses the ability of maintaining vascular homeostasis and regulating immune response. This study aims to examine the serum TL1A levels in KD patients, and to investigate the relationship between TL1A and CAAs in children with KD.Methods: Blood samples were recruited from 119 KD patients, 35 febrile controls (FCs) and 37 healthy controls (HCs). The KD group was further divided into KD with CAAs (KD-CAAs) and KD non-CAAs (KD-NCAAs) groups. Serum TL1A levels were measured using enzyme-linked immunosorbent assays, and clinical parameters were collected in KD patients. Results: Serum TL1A levels in the acute phase of KD patients were significantly higher than that in the FC and HC groups. In particular, serum TL1A were substantially increased in the KD-CAA group than that in the KD-NCAA group. Furthermore, TL1A levels were positively correlated with the duration of fever, time point of IVIG and WBC levels, but negatively correlated with levels of RBC, Hb and Albumin in the KD group. Conclusions: TL1A might be involved in the KD-associated vasculitis, and might be a factor in the development process of CAAs.

Abstract 192: Long Term Coronary Angiography of Giant Coronary Aneurysms after Kawasaki Disease in Mexican Children

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Luis M Garrido-Garcia ◽  
Jose L Colin ◽  
Alfredo Bobadilla-Aguirre
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Coronary Angiography ◽  
Coronary Stenosis ◽  
Unknown Etiology ◽  
Coronary Artery Lesions ◽  
Mexican Children ◽  
Coronary Aneurysms

Kawasaki Disease (KD) is an acute febrile illness characterized by systemic vasculitis of unknown etiology. Coronary artery aneurysms (CAA), is one of the most important aspects of this disease. Some patients with KD develop giant coronary aneurysms (z-score > 10) and coronary stenosis, leading to ischemic heart disease. Objective: To determine the outcome of giant coronary artery lesions caused by KD and the value of coronary angiography in the evaluation and follow-up of coronary artery lesions in Mexican children. Materials and Methods: From our Institutional database, 34 patients (23 men and 11 women) who developed giant aneurysms from 1995 to December 2013 were identified. Information on patient demographics, catheter and surgical interventions, and most recent status was collected from medical records. Results: The average age at onset of KD was 13.5 months, and the median observational period was 70 mo. (5 to 163 mo.). During this period 11 patients showed CAA regression, 21 patients persist with CAA and 2 patients died at follow-up. In 9 patients with persistent giant CAA or coronary stenosis we performed cardiac catheterization to evaluate the coronary anatomy and findings of myocardial ischemia. Coronary bypass was performed to alleviate coronary ischemia in 1 patient, this patient developed dilated cardiomyopathy one year after the surgery and died. The overall survival rate in our series is 97%. Conclusions: Despite being a small series, the long-term survival of patients with KD complicated by giant coronary aneurysms in our center is relatively good. However further research should focus on the indications for and effectiveness of percutaneous and surgical coronary interventions.

Abstract 203: Long-term Outcome Of Kawasaki Disease With Giant Coronary Aneurysms Which Waste Cardiac Follow-up; A Case Report

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Masanori Mizuno ◽  
Masahide Chikada ◽  
Yoshimitsu Tsuzuki ◽  
Hirokuni Ono ◽  
Masaki Arima ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Cardiopulmonary Arrest ◽  
Artery Aneurysm ◽  
Successful Resuscitation ◽  
Long Term Outcome ◽  
Stenotic Lesion ◽  
Coronary Aneurysms

We report 2 cases of Kawasaki disease (KD) which required surgical interventions long after initial diagnosis. Case 1: Twenty-one years-old male. He was diagnosed as KD at the age of 1. Despite he received intravenous gamma-globulin therapy, bilateral giant coronary aneurysms were formed. In addition, multiple aneurysms include abdominal, iliac and axillary arteries were formed simultaneously. Coronary angiography (CAG) was thought to be dangerous because of iliac artery aneurysm formation. He received medical follow-up with aspirin administration only. He referred to our department at the age of 13. Ischemic changes were confirmed on both treadmill exercise test and cardiac scintigraphy. CAG showed 75% right coronary artery (RCA) stenosis and 99% left main trunk stenosis. Coronary artery bypass grafting (CABG) was performed and his postoperative course has been uneventful. Case 2: Thirty-seven years-old male. He was diagnosed as KD at the age of 1. Left giant coronary aneurysms were formed and subsequently aneurysm was occluded. Aspirin was administrated, but he interrupted medication and follow-up for himself. He referred to our institution due to cardiopulmonary arrest during exercise. After successful resuscitation, CAG revealed total occlusion of RCA and 99% left coronary artery stenosis. Emergent CABG was performed and no postoperative sequel has occurred. Both cases didn’t receive sufficient assessment during the follow-up period. As a result, fatal cardiac event was occurred in case 2. Coronary aneurysm tends to change into combine aneurysmal and stenotic lesion. Long time follow up is necessary even if patients have no symptom. In addition, to decrease lost follow up patients, we should explain the risk of sudden cardiac death repeatedly and emphasis necessity of long term follow-up and medication.

scholarly journals High risk of coronary artery aneurysm in Kawasaki disease

Rheumatology ◽  
2020 ◽  
Author(s):  
Maria Mossberg ◽  
Aladdin J Mohammad ◽  
Fredrik Kahn ◽  
Mårten Segelmark ◽  
Robin Kahn
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
Demographic Data ◽  
Artery Aneurysm ◽  
Heart Association ◽  
Coronary Aneurysms ◽  
Immunoglobulin Treatment ◽  
Timely Treatment

Abstract Objective Kawasaki disease (KD) is a vasculitis of unknown aetiology with a high risk of coronary aneurysms if untreated. Timely treatment with intravenous immunoglobulin decreases the risk for coronary artery aneurysms (CAA). In this study, we set out to elucidate the factors associated with the risk of developing CAA. Methods Records of all KD-diagnosed children in Skåne between 2004 and 2014 were collected and clinical and demographic data were compiled. KD is defined according to the revised American Heart Association diagnostic criteria and classified as either complete KD (cKD) or incomplete KD (iKD). Results KD was diagnosed in 77 children and CAA was found in 31% (n = 24). Children with CAA were younger compared with children without (median; 20 vs 34 months) and intravenous immunoglobulin treatment within 10 days was less likely to be received (75% vs 91%). In children presenting with iKD, 47% developed CAA compared with 21% in cKD patients. Using multivariate analysis, an association between the risk of CAA with low age in children with iKD was observed. Conclusion The risk of CAA development is disturbingly high in young children with iKD. This highlights the importance of rapid intense treatment and vigilance in infants, who are the most difficult to diagnose, in order to reduce the frequency of CAA.

scholarly journals Transcatheter Aortic Valve Replacement Incidentalomas: A Multimodality Imaging Case of Giant Right Coronary Aneurysm

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Jamal Janjua ◽  
Esosa G. Odigie-Okon ◽  
Premnauth Rabindranauth ◽  
Richard J. Wittchow ◽  
Aiman Riaz
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Multimodality Imaging ◽  
Severe Aortic Stenosis ◽  
Artery Bypass ◽  
Artery Aneurysm ◽  
Coronary Aneurysms ◽  
Increased Risk

Giant coronary artery aneurysms (CAAs) are defined as having a diameter of greater than 2 cm. We report a case of an 82-year-old male with severe aortic stenosis incidentally diagnosed with giant right coronary artery aneurysm (gRCAA) while undergoing evaluation for transcather aortic valve replacement (TAVR). It was causing a mass effect on the right cardiac chambers but was otherwise asymptomatic. Our patient was successfully treated with surgical excision of aneurysm with concomitant coronary artery bypass grafting (CABG) and surgical aortic valve replacement (SAVR). The patient remained stable at discharge and on serial follow-ups for two years. In conclusion, due to the associated complication and increased risk of mortality with giant coronary aneurysms, we recommend surgical approach instead of medical management alone. We also call for evidence-based recommendations and guidelines for management of TAVR incidentalomas.

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