Enfermedad de Kawasaki complicada con aneurismas gigantes e infarto del miocardio. Informe de un caso

Introduction. Kawasaki disease is an acute vasculitis of unknown etiology whose main complication is the formation of aneurysms of the coronary arteries. The myocardial involvement is the main cause of death in these patients and it is more frequent in those with large aneurysms of the coronary arteries measuring 8 mm or more in diameter. Aneurysms of systemic arteries occur in 2% of the patients. Clinical case. A nine-month-old boy with a history of high fever for 24 days and the presence of four additional criteria for the diagnosis of Kawasaki disease. Various studies done during his hospitalization revealed aneurysms of both coronary arteries, aneurysms of both iliac arteries, thrombotic occlusions of the right coronary artery and a myocardial transmural inferior infarction as substantiated by the electrocardiogram, elevation of troponina I, scintillogram of myocardial perfussion and nuclear magnetic angioresonance. He was treated with acetylsalicilic acid, intravenous gammaglobulin, metilprednisolone pulses and heparin. At the present time he is asymptomatic; his ventricular ejection fraction is 52% and he continues to take captopril, acetylsalicilic acid and warfarin. Conclusions. Treatment with intravenous gammaglobulina has diminished the incidence of coronary artery dilatation to less than 5% and of giant aneurysms to less than 1%; mortality has been reduced from 2% to 0.3%. It is important to establish an early diagnosis and ideally to initiate treatment before the tenth day of illness, keeping in mind that the younger the patient and the longer the duration of the fever, the higher the incidence of larger coronary artery aneurysms and their complications.