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A 27 year old woman was admitted with a history of typical crescendo angina pectoris for 10 days. There were no abnormal findings at clinical examination. Consecutive ECGs showed symmetric negative T waves in precordial leads. Troponin I concentration was 2.5 ng/ml (normal range 0–1.6 ng/ml). There was no evidence of systemic inflammation in laboratory investigations. The patient's coronary risk factors comprised smoking (one pack a week) and hypercholesterolaemia (total cholesterol 243 mg/dl (6.28 mmol/l)).
Echocardiography showed normal left ventricular wall motion and heart valves. Coronary angiography was undertaken and revealed severe three vessel coronary artery disease with an occluded aneurysm of the right coronary artery adjacent to the ostium, and a huge calcified aneurysm of the left main coronary artery, including the proximal parts of the left anterior descending and the circumflex coronary artery (right). The distal parts of these two arteries were significantly altered with dilated and stenotic lesions. Using duplex sonography and angiography, aneurysms of the large arteries of the upper and the lower limbs could be excluded.
An extensive medical history revealed that 12 years previously the patient had experienced a severe, prolonged, unexplained febrile illness, with a maculopapular rash of the trunk, erythema followed by desquamation of the hands, sinusitis, cardiomegaly, serous meningitis, and cervical lymphadenopathy. Therefore a retrospective diagnosis of Kawasaki's disease was made.
After a successful aortocoronary bypass operation the patient made an uneventful recovery, and was discharged on aspirin, a statin, and a β blocker.