Four cases of Kawasaki syndrome complicated with myocarditis.
BACKGROUND
Myocarditis frequently occurs in the acute phase of Kawasaki syndrome (KS), and a few severe cases have been reported. Four cases of myocarditis in KS required additional catecholamine treatment because of severe left ventricular dysfunction (LVD).


METHODS
Three cases were relatively older children and 2 cases were complicated with encephalopathy. All 4 developed coronary artery abnormalities during convalescence. There was 1 case of LVD because of prolonged severe inflammation prior to administration of intravenous immunoglobulin (IVIG). The remaining 3 patients had normal values for ejection fraction before the administration of IVIG but decreased values (42-51%) and increased C-reactive protein levels after IVIG administration. These cases demonstrate an association between myocarditis in KS and severe or worsened inflammation.


CONCLUSIONS
Even with prior normal echocardiography, careful observation of cardiac function may be necessary for patients with KS, especially older children, when inflammation deteriorates after administration of IVIG.
Yoshikawa
Hideki
H
Division of Pediatrics, Graduate School of Medical and Dental sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan. yosshii@po2.synapse.ne.jp
Nomura
Yuichi
Y
Masuda
Kiminori
K
Hazeki
Daisuke
D
Yotsumoto
Keiko
K
Arata
Michiko
M
Kamenosono
Akira
A
Yanagi
Sadamitsu
S
Yoshinaga
Masao
M
Kawano
Yoshifumi
Y
D002395:Catecholamines / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003330:Coronary Vessel Anomalies / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000188:drug therapy*; D009205:Myocarditis / Q000150:complications / Q000188:drug therapy*; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000188:drug therapy
D002395:Catecholamines; D016756:Immunoglobulins, Intravenous