Clinical Case 23—Adult-onset recurrent Kawasaki disease complicated by coronary aneurysms and recurrent acute myocardial infarction

Summary of case: A 67-year-old man presented to the emergency department (ED) with acute chest pain. He had the previous diagnosis of Kawasaki disease (KD) made when he was 51 years-old in a event of a acute myocardial infarction. Upon admission, his blood pressure was 100/70 mm Hg, heart rate was 55 beats/min, apyretic. Clinical examination was unremarkable. Electrocardiogram showed a synus rhythm without any ST-T alterations. An echocardiogram showed mildly decreased left ventricular function (LVEF) of 44% by the biplane Simpson method, with hypokinesia of anterolateral and inferolateral wall, and enlargement of the ascendent aorta and aorta root. Cardiac enzymes were elevated, troponin-I 10.5 ng/mL and NTproBNP of 832 ng/mL. The diagnosis of acute myocardial infarction without ST segment elevation was made. Cardiac catheterization revealed diffuse aneurysmal dilation of the left anterior descendent artery and right coronary artery. Circunflex artery was occluded in the mid segment. Thrombotic aspiration was made and a drug-eluting stent was implanted. The patient showed clinical improvement and was discharged 4 days later with ticagrelor and aspirin.

This case illustrates the importance to recognize adult-onset KD as part of the differential diagnosis of chest pain with ST-segment elevation in a adult, even if uncommon. Early recognition is fundamental, permitting correct treatment and prevention of potentially fatal coronary complications.