Cardiovascular complications of mucocutaneous lymph node syndrome

Kawasaki disease in a Sudanese family

Kawasaki disease (mucocutaneous lymph node syndrome) is an acute inflammatory multisystem disease of children. The acute phase of the disease is characterized by high grade fever, conjunctivitis, exanthematous skin rash and non-suppurative lymph node enlargement. The subacute phase follows with the manifestations of arthritis, myocarditis and thrombocytosis. The disease is self-limiting in most children but is associated with coronary artery aneurysms in 15-20% of cases. The aetiology is unknown, but results of epidemiological studies suggest that an unidentified infectious agent might be the causative factor. Since the first description of the disease by the Japanese doctor, Tomisaku Kawasaki, in 1967 and his report for the English literature in 1974, thousands of cases have been reported worldwide. The highest prevalence is found in Japan and among the Japanese in Hawaii, followed by the United States. Although the disease was first reported in Africa in 1979, to date only four cases have been reported there. The following account reviews the literature and describes the manifestations of Kawasaki disease as seen in two siblings in Khartoum, Sudan.

Surgical presentation of Kawasaki disease (mucocutaneous lymph node syndrome)

Five patients with Kawasaki disease (mucocutaneous lymph node syndrome) are reported whose varied presentations included acute abdominal pain, peripheral arterial aneurysms, digital gangrene and sterile pyuria and whose presenting pathology ranged from hydrops of the gallbladder to enteric pseudo-obstruction. As the complications of the disease can usually be managed without resort to surgery, which is associated with a mortality rate of up to 25 per cent, the recognition of Kawasaki disease will prevent hazardous and unnecessary laparotomy.

Sudden death in children and young adults

Congenital cardiac lesions, whether unrepaired or postoperative, are among the most common diagnoses associated with sudden death in the 1- to 20-year-old range. In the general population, myocarditis, hypertrophic cardiomyopathy, and coronary artery anomalies are common causes of sudden cardiac death. Within the subset of pediatric cardiology patients who have not undergone operation, patients at greatest risk of sudden death are those with hypertrophic cardiomyopathy, Eisenmenger syndrome, and tetralogy of Fallot.

Kawasaki disease and its diagnosis

Mucocutaneous lymph node syndrome, or Kawasaki disease, is a febrile, exanthematous disease of children that has potentially fatal complications. The most important complication is the development of aneurysms in the coronary arteries, which may thrombose or occasionally, rupture and cause severe morbidity or death. Criteria for the diagnosis of Kawasaki disease have been developed that may help the clinician make the diagnosis and prevent complications. The major criteria include fever, skin eruption, ocular changes, oral changes, changes in the extremities, and lymphadenopathy. Prognosis may be evaluated by the clinical picture and cardiac work-up with echocardiogram.

Kawasaki disease in an Egyptian boy

Since its description in Japan in 1967, Kawasaki disease has been reported from several parts of the world but has been reported only once in an Arab child and never from the African continent. We report a typical case of Kawasaki disease in an Arab child in Africa who later developed coronary and several peripheral aneurysms.

Kawasaki syndrome

Kawasaki's syndrome is an acute, largely self-limited multisystem vasculitis of childhood with prominent rheumatic complaints, involving both the heart and the joints. Although the etiologic agent has not been discovered, the evidence appears overwhelming that a microbial agent is the responsible trigger for this multisystem disease. Immunologically mediated phenomena appear to be important in the development of the significant complications of KS carditis, coronary vasculitis, and arthritis. Although truly effective therapy is not yet available, there is an exciting possibility that immunologic treatment may have beneficial effect. More effective preventive and therapeutic methods will become available when the elusive agent is discovered.