Widened coronary arteries in a feverish child.
A 3-year-old girl with fever of unknown origin after a visit to Surinam was seen at our hospital. Signs and symptoms were indicative of either Kawasaki syndrome or an acute viral or (atypical) bacterial illness. No cardiac abnormalities were noted at echocardiography. She was treated with intravenous immunoglobulin and clarithromycin and made a quick recovery. Serologically, the diagnosis of murine typhus was made; a flea-borne rickettsiosis caused by Rickettsia typhi. A follow-up echocardiography 1 week later showed a dilated left coronary artery, which was normal again 4 weeks later. We suggest that this phenomenon was a manifestation of rickettsial vasculitis.
van Doorn
H Rogier
HR
Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Room L1-245, P. O. BOX 22660, 1100DD Amsterdam, The Netherlands. H.R.vanDoorn@amc.nl.
Lo-A-Njoe
Shirley M
SM
Ottenkamp
Jaap
J
Pajkrt
Dasja
D
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002675:Child, Preschool; D017291:Clarithromycin / Q000627:therapeutic use; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology*; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000382:microbiology; D005260:Female; D005334:Fever / Q000382:microbiology*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D016896:Treatment Outcome; D014437:Typhus, Endemic Flea-Borne / Q000150:complications* / Q000188:drug therapy; D014463:Ultrasonography
D000900:Anti-Bacterial Agents; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D017291:Clarithromycin