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Unusual Presentation of Kawasaki Disease Complicated by Coronary Aneurysms

Journal of the Korean Pediatric Society 1994;37(7):890-899.
Published online July 15, 1994.
Unusual Presentation of Kawasaki Disease Complicated by Coronary Aneurysms
Young-Ah Lee, In-Sook Park, Young-Hwue Kim, Hyung-Nam Moon, Chang-Yee Hong
Department of Pediatrics, Ulsan University Medical School, and Asan Medical Center, Seoul, Korea
관상동맥류의 발견으로 후향적으로 진단된 가와사끼병
이영아, 박인숙, 김영휘, 문형남, 홍창의
울산대학교 의과대학 아산재단 서울중앙병원 소아과학교실
Patients with atypical or incomplete Kawasaki disease are at same risk for development of coronary artery complications as typical Kawasaki disease. In this communication we report six patients with unusual presentation of Kawasaki disease complicated by coronary artery aneurysms, in whom correct diagnosis were not made in time for proper treatment. One of these patients died from massive myocardial ischemia due to giant aneurysms along the entire coronary artery system. These patients had either less than enough number of diagnostic criteria at initial presentation or diagnostic signs which occurred over an extended period of time, resulting in difficulty in diagnosis during the acute phase. As a result, none of these patients received intravenous gamma globulin treatment. Thus strict adherence to currently accepted criteria for diagnosis of kawasaki disease may lead to failure to recognize atypical form of this illness with potential sequelae of myocardial ischemia or sudden death. We would like to emphasize from this experience that clinicians must be aware of the wide variations in clinical presentation of Kawasaki disease and take an aggressive approach in making correct diagnosis by obtaining early cardiac evaluation in order to initiate prompt treatment with intravenous gamma globulin.
Key Words: Atypical Kawasaki disease, Coronary artery aneurysm

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