Diagnosis and management of Kawasaki disease
W. M. Gersony
Division of Pediatric Cardiology, College of Physicians and Surgeons, Columbia University, New York, NY.
Kawasaki disease is an acute vasculitis characterized by mucosal
inflammation, rash, cervical adenopathy, indurative edema of the hands and
feet, and late membranous desquamation of the fingertips. Early cardiac
effects include myocarditis (occasionally with congestive heart failure),
pericardial inflammation, and, rarely, valve involvement. Coronary artery
aneurysms are a long-term concern because coronary thrombosis with
myocardial infarction can be a late manifestation. The origin of Kawasaki
disease is unknown, but an infectious agent is most likely. Management
consists of aspirin for control of fever and inflammatory manifestations
and intravenous gamma globulin for the prevention of coronary aneurysm
formation. Careful late follow-up is required, especially for patients with
persistent coronary abnormalities. Giant aneurysms (greater than 8 mm) are
more likely to progress to coronary obstructive disease, and coronary
bypass grafts have been required for some patients. Late coronary artery
manifestations in patients with mild early coronary dilatation have not
been described. However, since long-term epidemiologic studies have not yet
been performed, it is prudent to consider childhood Kawasaki disease to be
a potential risk factor for coronary disease, especially in
atherosclerosis-prone Western societies.
