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Management of Kawasaki disease in adults
  1. Kara J Denby1,
  2. Daniel E Clark1,
  3. Larry W Markham2
  1. 1 Departments of Internal Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, USA
  2. 2 Divisions of Cardiovascular Medicine and Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, USA
  1. Correspondence to Dr Kara J Denby, Vanderbilt University Medical Center, Departments of Internal Medicine and Pediatrics, 1215 21st Avenue South Medical Center East, 7th Floor, North Tower, Suite 2 Nashville, TN 37232-7854, USA; k.denby{at}vanderbilt.edu

Abstract

Kawasaki disease is the most common childhood vasculitis in the USA and the most common cause of acquired cardiac disease in children in developed countries. Since the vast majority of Kawasaki disease initially presents at <5 years of age, many adult cardiologists are unfamiliar with the pathophysiology of this disease. This vasculitis has a predilection for coronary arteries with a high complication rate across the lifespan for those with medium to large coronary artery aneurysms. An inflammatory cascade produces endothelial dysfunction and damage to the vascular wall, leading to aneurysmal dilatation. Later, pseudonormalisation of the vascular lumen occurs through vascular remodelling and layering thrombus, but this does not necessarily indicate resolution of disease or reduction of risk for future complications. There is a growing prevalence of Kawasaki disease, making it increasingly relevant for adult cardiologists as this population transitions into adulthood. As the 2017 American Heart Association (AHA) and 2014 Japanese Circulation Society (JCS) guidelines emphasise, Kawasaki disease requires rigorous follow-up with cardiac stress testing and non-invasive imaging to detect progressive stenosis, thrombosis and luminal occlusion that may lead to myocardial ischaemia and infarction. Due to differences in disease mechanisms, coronary disease due to Kawasaki disease should be managed with different pharmacological and non-pharmacological treatment algorithms than atherosclerotic coronary disease. This review addresses gaps in the current knowledge of the disease and its optimal treatment, differences in the AHA and JCS guidelines, targets for future research and obstacles to transition of care from adolescence into adulthood.

  • Kawasaki disease
  • transition of care
  • coronary aneurysms
  • acute coronary syndrome
  • myocardial infarction

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Footnotes

  • Contributors KD and DEC were both involved in the conceptualisation of the project. KD wrote the manuscript with significant input from DEC and LWM. All authors assisted with editing the manuscript. All authors reviewed the final manuscript and approve its content. The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive license (or non-exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd and its Licensees to permit this article (if accepted) to be published in HEART editions and any other BMJPGL products to exploit all subsidiary rights.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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