[Kawasaki disease is also a disease of adults: report of six cases].
Kawasaki disease is an inflammatory arterial disease of unknown cause usually affecting young children, the principal complication of which is coronary artery aneurysm. Early treatment with immunoglobulins and aspirin prevents this complication. The diagnosis requires expert clinical criteria and, in atypical forms, a more recent decisional diagnostic tree has to be used. The authors report 6 cases of adult Kawasaki disease. As in the other sixty or so cases in the literature, hepatic forms were the commonest (5/6). Only three of the six cases met the classical clinical criteria and the diagnosis was made by the decisional tree or after coronary complications in the oldest subject. The five treated patients progressed favourably after a course of immunoglobulins. Echocardiography detected 100% of children with coronary disease but it was more difficult in adults in whom new non-invasive methods of coronary imaging (fast CT and MRI) and stress testing should complete the investigations. The association of prolonged pyrexia, clinical criteria and a biological inflammatory syndrome should, after exclusion of the differential diagnoses, suggest a diagnosis of Kawasaki disease in the adult as in the child. The possibility of coronary disease, even though extremely rare, should be recognised by the cardiologist and lead to diagnostic and therapeutic managements as aggressive as in children.
Dauphin
C
C
CHU Clermont-Ferrand, Hôpital Gabriel-Montpied, Service de cardiologie et maladies vasculaires, 63003 Clermont-Ferrand. cdauphin@chu-clermontferrand.fr
Motreff
P
P
Souteyrand
G
G
Laurichesse
H
H
Gourdon
F
F
Lesens
O
O
Lamaison
D
D
Beytout
J
J
Cassagnes
J
J
Lusson
J-R
JR
D000328:Adult; D003323:Coronary Aneurysm / Q000175:diagnosis; D017023:Coronary Angiography; D003663:Decision Trees; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009080:Mucocutaneous Lymph Node Syndrome / Q000175:diagnosis*; D009205:Myocarditis / Q000175:diagnosis; D010490:Pericardial Effusion / Q000175:diagnosis; D010493:Pericarditis / Q000175:diagnosis
D007136:Immunoglobulins; D007155:Immunologic Factors