What Happens If Kawasaki Disease Goes Untreated?

Blood vessels are present in every part of the body and if there is any disorder in the blood vessel, the disease may have a multiorgan impact. Such is the case with Kawasaki disease. If left untreated, it may lead to complications in various organs.

What Happens If Kawasaki Disease Goes Untreated?

The untreated form of Kawasaki disease causes life-threatening complications in the patients and leaves an impact on physical and emotional health. The Kawasaki disease should be properly treated, and the conditions should be coped by following various strategies. Following are the various complications due to Kawasaki disease:

Cardiovascular Complications: Cardiovascular complications are the common conditions in patients with Kawasaki disease. It significantly affects the morbidity and mortality of these patients. The various cardiovascular complications involve coronary artery (CA) aneurysms, peripheral arterial occlusion, heart failure, and myocardial infarction, reduced myocardial contractility, and cardiac arrhythmia. The risk of cardiovascular complication is high in untreated patients as compared to treated patients. (1)

Kawasaki Disease Shock Syndrome: The patient suffering from Kawasaki disease may develop a life-threatening condition known as shock syndrome. The condition is characterized by low blood perfusion and the blood pressure reduces sharply in such cases. It should be noted that the treatment of such shock due to Kawasaki disease is the administration of intravenous immunoglobulin which is not appropriate for the treatment of other shocks. The symptoms of Kawasaki disease shock syndrome are anemia and thrombocytosis.

Macrophage Activation Syndrome: The condition is also known as secondary hemophagocytic lymphohistiocytosis. It is a life-threatening complication of Kawasaki disease. It is generally the underrecognized complication as the pathophysiology and cause of the disease is not clear. The symptoms that may indicate the presence of macrophage activation syndrome in Kawasaki disease are hyperferritinemia, hypertriglyceridemia, elevated serum LDH, cytopenia, hypofibrinogenemia, and hepatic dysfunction. Splenomegaly may also indicate the presence of macrophagic activation syndrome.

Urinary Tract Complications: The complications of Kawasaki disease may also involve the kidney and urinary tract. These complications may be due to the inflammation of the renal parenchyma caused by T-cell activation. Vasculitis may also cause vascular endothelial injury in the renal artery. The symptoms of kidney and urinary tract complications include hemolytic uremic syndrome, tubulointerstitial nephritis, prerenal acute kidney injury, and pyuria.

Gastrointestinal Complications: GIT involvement is a common occurrence in the patient with Kawasaki disease and the rate of involvement is around 2.3%. The general symptoms are hepatomegaly, paralytic ileus, diarrhea with abdominal pain, vomiting, and abdominal distension. However, the complications of the GIT are quite rare and include appendicular vasculitis and hemorrhagic duodenitis. The condition may be caused due to severe inflammation in the muscular layer and other layers of the intestine and shows the signs of necrosis and degeneration.

Nervous System Complications: Kawasaki disease also affects the nervous system. Various symptoms related to the complications of the nervous system include myositis, epilepsy, and hemiplegia. Facial nerve palsy has also been seen in various patients. Analysis of cerebrospinal fluid also indicates the presence of pleocytosis.

Treatment Of Complications

Although the Kawasaki disease can be managed effectively if remains untreated due to reasons such as due inaccurate diagnosis, may lead to serious complications. Almost 25% of untreated patients develop life-threatening complications. The more aggressive treatment strategy is required to manage the complications. Following are the treatment options for such patients:

Medications: Various medications such as antiplatelet and anticoagulants, the medicines which prevent the clot formation, are used.

Surgery: Various surgeries can be advised by the cardiologist on the basis of disorder occurred due to complications. When the coronary artery gets blocked, the treatment advised may be coronary angioplasty through which the blocked artery be opened. But if the coronary angioplasty is not possible, then coronary artery bypass graft may be advised.

Conclusion

Apart from the cardiac complications, the Kawasaki disease may lead to gastrointestinal, nervous system and kidney complications.

References:

  1. https://adc.bmj.com/content/79/2/198.6

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