title: Refractory progression of coronary aneurysms, a case of delayed onset Kawasaki disease as depicted by cardiac computed tomography angiography.
abstract: BACKGROUND
  Kawasaki disease (KD) is an immune-mediated vasculitis of unknown etiology with self-limited clinical course that was first described in 1967 by Dr. Tomisaku Kawasaki. It is a disease of early childhood and rare past late adulthood but one that can have detrimental consequences when there is a delay in diagnosis and treatment. Cardiovascular complications causing increased morbidity and mortality may include coronary artery aneurysms, myocardial infarction, heart failure, arrhythmias, and peripheral artery occlusion.
  
  
  METHODS
  Here, we present an atypical case of delayed onset KD in a young teenager. DS had visited three different emergency departments during the course of 2 weeks for unrelenting fevers. Despite multiple treatment protocols including immunoglobulin, steroids, and tumor necrosis factor-alpha antagonists, he continued to have progression of cardiovascular complications. While echocardiographic findings were suspicious for cardiac complications, a cardiac computed tomography (CT) angiography was able to clearly distinguish giant coronary aneurysms.
  
  
  CONCLUSIONS
  Without prompt therapy, fever and manifestations of acute inflammation can last for several weeks to months with increased risk toward complications. The incidence of coronary artery aneurysms has been noted to be 25% in untreated patients with a mortality rate of up to 2%. Using low-dose protocols along with high spatial and temporal resolution of cardiac CT angiography may provide a useful and complimentary imaging modality in accurate diagnosis and follow-up of patients with KD.
authors.affiliation: Division of Cardiovascular Diseases, New York Medical College, Valhalla, New York 10595, USA. syntaxmax@aol.com
authors.forename: Shah
authors.initials: S
authors.lastname: Azmoon
authors.forename: David
authors.initials: D
authors.lastname: Atkinson
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D017023:Coronary Angiography / Q000379:methods*; D006801:Humans; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography