title: Fatal Kawasaki disease with incomplete criteria: Correlation between optical coherence tomography and pathology.
abstract: Coronary artery aneurysm is a serious complication of Kawasaki disease (KD). A 3-month-old infant presented with severe KD 27 days after onset of fever. The patient presented with shock, inferolateral ischemia on electrocardiogram and high troponin. Echocardiography showed severe myocardial dysfunction with diffuse coronary dilation and right coronary artery aneurysm. Arterial Doppler demonstrated thrombosis of aneurysmal axillary and iliac arteries. Withdrawal of support was implemented due to multi-organ failure. Post-mortem optical coherence tomography correlated with pathology. The pulmonary artery was normal on OCT and histology. Coronary arteries showed aneurysmal dilatation, with intimal hyperplasia and preserved media on OCT. Pathology confirmed these findings, with destruction of the internal elastic lamina, luminal myofibroblastic proliferation, neovascularization, and partial disappearance of the media. This is the first report of pathologic correlation in KD with OCT at the subacute stage, which adequately identified structural wall changes.
authors.affiliation: Division of Pediatric Cardiology, CHU Saint Justine, Montreal, Canada.
authors.forename: Audrey
authors.initials: A
authors.lastname: Dionne
authors.affiliation: Division of Pathology, CHU Saint Justine, Montreal, Canada.
authors.forename: Victor
authors.initials: V
authors.lastname: Kokta
authors.affiliation: Division of Pathology, CHU Saint Justine, Montreal, Canada.
authors.forename: Rose
authors.initials: R
authors.lastname: Chami
authors.affiliation: Division of Pediatric Intensive care, CHU Saint Justine, Montreal, Canada.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Morissette
authors.affiliation: Division of Pediatric Cardiology, CHU Saint Justine, Montreal, Canada.
authors.forename: Nagib
authors.initials: N
authors.lastname: Dahdah
mesh_terms: D003323:Coronary Aneurysm / Q000175:diagnosis / Q000209:etiology*; D003331:Coronary Vessels / Q000473:pathology*; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005334:Fever / Q000150:complications*; D006801:Humans; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications* / Q000175:diagnosis; D009206:Myocardium / Q000473:pathology*; D041623:Tomography, Optical Coherence / Q000379:methods*
keywords: Kawasaki disease; coronary aneurysm; optical coherence tomography; pathology; pediatric