Can Kawasaki Disease Cause Aneurysms?

Kawasaki disease is characterized by the inflammation of blood vessels throughout the body. The main characteristic of the disease is high fever which lasts for more than 5 days and does not subside even after commonly used antipyretics which is followed by peeling of skin. The lymph nodes across the neck are enlarged, there will be rashes, reddening of eyes, lips, palms, and sole. The blood vessel which supplies blood to the heart becomes inflamed resulting in swelling of the coronary arteries and in the long run it causes coronary artery aneurysms within a couple of years. There will be abnormal dilation of coronary arteries. In acute form of the disease, there will be systemic inflammation affecting many organs of the body causing myocarditis, pericarditis, aseptic meningitis, arthralgia, arthritis, pneumonitis, lymphadenitis, and hepatitis. There will be an increased number of white blood cells in the body indicating inflammation.

Can Kawasaki Disease Cause Aneurysms?

Kawasaki disease if left untreated causes heart diseases in 1% of the population and coronary aneurysms if occurred cannot be recovered. Such patients are at increased risk of myocardial infarction and death. Timely treatment can prevent cardiovascular events. (1)

Kawasaki disease can be divided into three clinical phases’ acute febrile phase, sub-acute phase and recovery phase. The acute phase is characterized by high fever, erythema, swelling of hands and feet, aseptic meningitis and diarrhea. Myocarditis can happen during this time. There will be symptoms of coronary arteritis and pericardial effusion. Aneurysms may not be diagnosed during this phase. Sub-acute phase starts when fever, rash and lymphadenopathy symptoms begin to subside which usually takes up to 2 weeks. There will be peeling of the skin of fingers and toes. Subacute phase has coronary artery aneurysms. There will be an increased risk of death due to heart failure. This will be followed by a recovery phase where all the clinical sign of Kawasaki disease disappear and the body returns to the recovery phase. (2)

Heart disease is the main complications of Kawasaki disease. It is one of the main heart diseases that happen in children in the United States and Japan. Coronary artery aneurysms occur in children due to vasculitis in up to 25% of the patients. The aneurysms are diagnosed after 10 days of the onset of the disease and usually happen within 4 weeks of disease onset. Depending upon the extent to dilation of the coronary arteries, the aneurysm can be classified into small, medium, and giant. Saccular and fusiform aneurysms develop within 18-25 days of the onset. (3)

The treatment of Kawasaki disease is started after 5 days of onset of the disease and it is advised to start treatment after 5 days only. The treatment is comprised of high-dose IVIG and antipyretics. 5% of the patients even after treatment proceed to develop transient coronary artery dilation which can further develop into giant aneurysms. The death in such cases results due to myocardial infarction, a blood clot in the aneurysm or rupture of the same. Death due to aneurysm can happen within 12 weeks of illness. The possible causes of aneurysm include low hemoglobin, low albumin, increases WBC, high CRP concentration and age less than one year. The recovery of aneurysm usually happens within two years of dilation. The blood vessel starts narrowing as part of the healing process, the constriction of the blood vessel decreases the supply of oxygen and blood to the heart resulting in myocardial infarction. (4)

Aneurysms can be treated by percutaneous transluminal angioplasty, bypass grafting, coronary artery stenting, and even cardiac transplantation. The extent of recovery depends upon the size of aneurysms

Echocardiogram and angiography help in the diagnosis of aneurysms in Kawasaki disease. The visible symptoms subside on their own, but the heart disease requires treatment which can turn fatal. In general, children with Kawasaki disease will have a bad cardiovascular profile with high blood pressure, increased weight and high cholesterol levels.

Conclusion

One of the major life-threatening complications of Kawasaki disease is aneurysms. There will be dilation of the blood vessel and while healing the constriction of the vessel decreases the supply of oxygen and blood resulting in myocardial infarction and death. The size of the aneurysm determines the intensity of damage.

References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826559/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3888612/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803562/
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803562/

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