ADULT-ONSET KAWASAKI-DISEASE DIAGNOSED BY THE ECHOCARDIOGRAPHIC DEMONSTRATION OF CORONARY ANEURYSMS

A 17-year-old boy presented with fever; bilateral conjunctival infecti on, angina and extensive cervical adenopathy. Amoxycillin was started. Ten days later he was admitted to hospital because of persistant high fever; cervical adenopathy, erythrema of the pharynx and tongue and l ip fissuration. The most important interventions of his first hospital ization were endotracheal intubation because of increasing dyspnoea du e to adult respiratory distress syndrome and haemodialysis for renal i nsufficiency. His admission to our hospital was mal ked by the echocar diographic discovery of giant coronary aneurysms in the first few cent imeters of both right and left coronary arteries. Coronary angiography confirmed giant aneurysm formation of the light and left coronary art eries Similarly, medium sized arteries (cerebral, hepatic, mesenteric, iliac) presented abnormalities on angiography. Kawasaki syndrome was the final diagnosis, based on clinical presentation, coronary artery a bnormalities and laboratory findings. This is the first description of adult-onset Kawasaki disease with giant coronary aneurysm formation a nd more generalized arterial involvement. The severity of the clinical symptoms and the severity of the coronary disease indicates that Kawa saki disease of the adult does not always have a benign course.