An autopsy case of Kawasaki disease with reference to occurrence of acute coronary thrombosis in the convalescent stage.
A one-year, four month-old boy who had suffered from Kawasaki disease died suddenly during convalescence despite intensive gamma-globulin treatment. Autopsy revealed a) sausage-like aneurysms of the left and right coronary arteries and fresh thrombosis in the right coronary aneurysm, b) fresh transmural myocardial necrosis in the whole wall of the left ventricle and the anterior part of the wall of the right ventricle, and c) swelling of the cervical lymph nodes and thymus (60 g). Histologically, fibrocellular thickening of the intima and destruction of the media and internal elastic lamina were conspicuous in the area of the aneurysm, but those of the intima and media in the areas adjacent to the aneurysm were mild. Abrupt narrowing of the lumen at the border between the aneurysm and periphery of the right coronary artery was detected, and this may have been responsible for formation of the thrombus in the right coronary aneurysm. In the systemic arteries, perivascular fibrosis was very noticeable despite less severe injury to the intima and media. These findings suggest that severe inflammation of the periarterial regions was present in the acute phase. The lymph system still showed inflammation, supporting the infectious or toxic nature of Kawasaki disease.
Naganuma
H
H
Division of Pathology, Sendai City Hospital, Japan.
Kyogoku
M
M
Abe
J
J
Fukui
K
K
Inoue
S
S
Yamamoto
K
K
Kato
S
S
Nakagawa
H
H
D000208:Acute Disease; D002102:Cadaver; D002533:Cerebral Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D003331:Coronary Vessels / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D009206:Myocardium / Q000473:pathology; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D014057:Tomography, X-Ray Computed