Adult Kawasaki disease - a rare and challenging diagnosis: a case report
T O’ Connor, C McNally, M W Kennedy- Cardiology and Cardiovascular Medicine
Abstract
Background
Kawasaki disease is an acute systemic vasculitis which predominantly occurs in childhood, but rarely in adulthood. Diagnosis relies on the presence of typical clinical features, however patients may present atypically- increasing the challenge of timely diagnosis for physicians.
Case Summary
We report a case of a 40 year old male presenting with persistent fever, rash and unilateral neck swelling. Initial investigations were suggestive of necrotising lymphadenitis, with a presumed infective aetiology. However, extensive microbiology and immunological investigations remained negative. Cardiac injury was evident with elevated Troponin T and NT-pro-BNP however left ventricular systolic function was normal. After 4 days, clinical features consistent with Kawasaki disease were noted and the results of a lymph node biopsy supported this diagnosis. Despite timely treatment with IVIG and high dose aspirin, follow up CT coronary angiography demonstrated 2 sequential aneurysms (max 6mm) in the right coronary artery, plus one small subtle aneurysm in the proximal left anterior descending artery (4mm).
Discussion
Diagnosis of Adult Kawasaki disease remains challenging, as symptoms often present sequentially over time rather than simultaneously and many of the clinical features necessary for diagnosis share commonality with other infectious disease processes.