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G262 Can early aggressive treatment of Kawasaki disease with coronary artery involvement aid in resolution in coronary artery aneurysms/dilation? A case series of three children
  1. MJ Baker1,2,
  2. DP Hawley1,
  3. A McMahon1
  1. 1Rheumatology, Sheffield Children’s Hospital, Sheffield, UK
  2. 2Paediatrics, Diana Princess of Wales Hospital, Grimsby, UK

Abstract

Methods Here were present a case series of three children with Kawasaki disease or atypical Kawasaki disease (KD) who were seen in a tertiary hospital in 2015 and received early aggressive treatment.

Results Case one: A three month old girl with atypical KD. Treated with IVIG and high dose aspirin on day six, resulting in resolution of pyrexias until day thirteen. Echocardiogram on day sixteen showed: right coronary artery (RCA) 2.4mm and left coronary artery (LCA) 2.8mm. Treated on day sixteen with second dose of intravenous immunoglobulins (IVIG) and seven days IV methylprednisolone (IVMP) then oral prednisolone and infliximab on day 31 (received a total of three doses). Maximal dilatations were of RCA2.7 and LCA 3.1. Repeat echocardiogram on day 89 showed RCA 1.8mm and LCA 1.3mm.

Case two: A two year ten month old girl with typical KD. Treated with IVIG on day six with good response but return of pyrexia, conjunctivitis and irritability on day fourteen. Day fifteen echocardiogram showed LCA 4.6mm, RCA 6.2mm and aortic root inflammation. Treated with a second dose of IVIG, high dose aspirin and four days high dose IVMP followed by oral prednisolone. Day fifty-one repeat echo showed LCA normal (no measurement given) and RCA 4mm with resolution of the aortic root inflammation.

Case three: A seven week old girl with atypical KD diagnosed at day 13 following an echocardiogram showing dilated coronary arteries. Treated with two doses of IVIG, aspirin and three days of IVMP followed by oral prednisolone. Initial echocardiogram showed LCA 4.8mm, RCA 2.5mm, LAD 3.0mm. Infliximab was given on day eighteen. Day twenty echocardiogram showed LCA 4.8mm, RCA 4mm and LAD 5.6mm. A repeat echo on day forty-eight showed LCA 4.4mm, RCA 2.4mm and LAD now normal.

Conclusions These cases suggest a role for early aggressive treatment in KD with known coronary artery involvement.

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