title: Cerebral vasculitis in severe Kawasaki disease: early detection by magnetic resonance imaging and good outcome after intensive treatment.
abstract: Kawasaki disease is an acute vasculitis, that has a classic complication of acquired coronary artery aneurysm. Severe forms with multi-organ involvement or neurological dysfunction are rare. Cerebral vascular involvement has been related to large-vessel injury or cardioembolism, leading to focal brain infarction. A 4-year-old female presented with unusual, rapidly catastrophic Kawasaki disease with refractory shock, acute renal failure, and coma, requiring intensive haemodynamic management. The observation of diffuse micro-haemorrhages (T2*-weighted sequence) associated with white matter injury on brain magnetic resonance imaging (MRI) pointed towards lesions of the medium/small blood vessels. Cerebral vasculitis was suspected and the immunosuppressive treatment was increased Subsequently, the patient's recovery was rapid. On follow-up severe, bilateral vitritis was evident and surgery improved visual outcome. Early recognition of severe or unusual forms of Kawasaki disease could lead to more favourable outcome using appropriate treatment strategies. Diffuse cerebral micro-haemorrhages on T2* brain MRI sequences might be a key sign for the diagnosis of medium or small cerebral vessel involvement.
authors.affiliation: Paediatric Neurology Department, Necker-Enfants Malades Hospital, Paris, France. cyril.gitiaux@nck.aphp.fr
authors.forename: Cyril
authors.initials: C
authors.lastname: Gitiaux
authors.forename: Manoelle
authors.initials: M
authors.lastname: Kossorotoff
authors.forename: Jean
authors.initials: J
authors.lastname: Bergounioux
authors.forename: Elias
authors.initials: E
authors.lastname: Adjadj
authors.forename: Fabrice
authors.initials: F
authors.lastname: Lesage
authors.forename: Nathalie
authors.initials: N
authors.lastname: Boddaert
authors.forename: Marie
authors.initials: M
authors.lastname: Hully
authors.forename: Dominique
authors.initials: D
authors.lastname: Brugel
authors.forename: Isabelle
authors.initials: I
authors.lastname: Desguerre
authors.forename: Brigitte
authors.initials: B
authors.lastname: Bader-Meunier
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001921:Brain / Q000473:pathology; D002675:Child, Preschool; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008279:Magnetic Resonance Imaging; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000601:surgery; D012720:Severity of Illness Index; D016896:Treatment Outcome; D020293:Vasculitis, Central Nervous System / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents