Atypical kawasaki disease (KD) in an HIV-infected adolescent - 25/08/11
Abstract |
Rationale |
Kawasaki disease-like syndrome (KDLS) has been described in HIV-infected individuals. However, coronary artery abnormalities have not been reported in these patients.
Methods |
A 14-year-old boy with advanced perinatal HIV infection and ITP required hospital admission for fever and bilateral hand swelling of 3 days duration. Generalized erythematous rash, palmar erythema, and conjunctivitis were noted on examination. Blood, urine, and throat cultures were negative. HIV-1 RNA was 990,000 copies/mL and CD4 count was 10 cells/mm3 (1%). All medications including didanosine, stavudine, tenofovir, enfuvirtide, azithromycin, and atovaquone were discontinued for a suspected drug reaction. High fever (Tmax 104.7°F) persisted despite 5 days of intravenous nafcillin and cefotaxime. Baseline echocardiogram revealed normal coronary anatomy. A diagnosis of presumed KDLS was made. Intravenous gamma globulin (2g/kg) was administered with resolution of patient's fever and conjunctivitis within 24 hours. Aspirin therapy was not initiated secondary to ITP.
Results |
Three weeks later, ectasia of multiple coronary arteries (measuring up to 5.0 mm) was seen on echocardiogram. Desquamation was noted. One month later, a proximal saccular aneurysm of the left anterior descending artery was seen. Four months after presentation, the coronary aneurysms resolved. The patient remains well without recurrence of symptoms.
Conclusions |
We report a case of atypical KD with coronary artery aneurysm formation in an HIV-infected adolescent. The development of KD in an extremely immunocompromised patient with ITP and lymphocytopenia implicates infection, rather than lymphocyte-dependent processes, in the pathogenesis of KD.
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Vol 113 - N° 2S
P. S126 - février 2004 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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