185 Coronary aneurysm – a reality in Kawasaki disease associated to COVID 19

Introduction Kawasaki disease is an acute febrile vasculitis, primarly affecting children, that is epidemiologically and clinically closely linked to a viral infection (2). This entity can sometimes have severe forms. Numerous clinical studies published in the last two years have shown that infection with SARSCoV2 virus (COVID 19) in children is frequently associated with this entity, which can sometimes be severe. We will present the case of a 9-month-old infant, without personal history, who was hospitalized for fever. The onset of the disease was 14 days earlier, with high fever and rash. He was hospitalized in another clinic, where the diagnosis of Covid 19-associated Kawasaki Disease was established (the criteria were as follows: fever for longer than 5 days, papulo-erythematous rash on the chest and limbs, changes in the oral and lip mucosa, palmo-plantar edema, bilateral conjunctivitis, Ig G anti SARS CoV2=4.52u/ml). He received treatment with Gamma globulin 2g/kg in single dose, corticosteroid therapy, Aspirin. The evolution was initially favorable. But after 7 days, high fever reappeared. Then, he is hospitalized in our clinic. At admission he had high fever, hyperemic lips, bilateral conjunctivitis, no manifestations of cardiac dysfunction, leukocytosis: 26,700/mmc, marked inflammatory syndrome (ESR=130 mm/ h, C-reactive protein=8.8 mg/dl). Cardiac ultrasound detects an aneurysm of the coronary arteries (RCA=3.5mm, Z score=6, LCA=2.5mm, Z score=1.43). The diagnosis of Kawasaki disease refractory to immunoglobulin treatment has been established, resuming administration in a dose of 400 mg/kg of body weight/day for 3 days. Treatment was supplemented with intravenous methylprednisolone pulse therapy, aspirin and enoxaparin.(1) The evolution was favorable with the remission of clinical symptoms and inflammatory syndrome, but with the persistence of coronary dilation. He was discharged from hospital with good general condition, normal inflammatory markers, changes in lipid profile (total cholesterol=306 mg/dl, total lipids=951 mg/dl, triglycerides=172 mg/dl) and indications of treatment with Medrol 2 mg/kg with gradual reduction of dosage and Aspirin 4mg/kg. After about 1 month he returns for revaluation, showing good general condition, upward weight curve, biological samples within normal limits. Ultrasound cardiological reassessment and CT angiography further reveal significant aneurysmal dilatation of the left coronary artery. Anticoagulant treatment was completed with enoxaparin. Conclusions KAWASAKI disease associated with COVID 19, may present an unfavorable outcome with lack of response to the initial immunoglobulin treatment and evolution to coronary aneurysm.