INCOMPLETE KAWASAKI-DISEASE WITH GIANT CO RONARY-ARTERY ANEURYSMS

Aneurysms of the coronary arteries are a well-known complication of Ka wasaki disease and will be found most often in cases with complicated initial course of the disease. In infancy this complication might occu r also in incomplete Kawasaki disease. A six month old boy was admitte d to an outside hospital for sudden onset of fever, a polymorphous exa nthema and bilateral conjunctival injection. Erythrocyte sedimentation rate, C-reactive protein and thrombocyte count were only slightly ele vated. Incomplete Kawasaki disease was suspected and a therapy with as pirin (75 mg/kg/day) and prednisolon (2 mg/kg/day) instituted, because the parents refused an immunoglobuline therapy. The child improved qu ickly and was discharged on the 10th day of the disease. 10 days later a control echocardiography in our institution revealed coronary arter y involvement. Cineangiography showed giant aneurysms of both coronary arteries with maximal diameters of 12 mm. An aneurysm of the left axi llar artery was clinically suspected and diagnosis was established by color doppler sonography. Immunoglobulines were administered in a sing le dose of 2 g/kg over a 12 hour period. Aspirin therapy was continued and Phenprocoumon (Marcumar) was added for long-term anticoagulation, The child is doing well for 12 months now. Echocardiography and angio graphy do not show any significant change in the size of the aneurysms . Giant coronary artery aneurysms might develop in the incomplete form of the Kawasaki disease with less severe acute illness. Early diagnos is and treatment with immunoglobulines might be able to prevent this c omplication.