ИСТИНА

Background and aims: An atypical form of AMI was observed in a child with Kawasaki disease. Methods: A child M. at 2y 7m fell acutely ill: fever, cough, rash, cheilitis, scleritis, knee pain, and abdominal pain. He received antibiotic therapy (Amoxicillin), hospitalized (day 14) for acute appendicitis, but diagnosed with Kawasaki disease. ECG: no pathology; echocardiography: coronariitis; lab tests: leukocytosis, thrombocytosis, anemia, accelerated ESR, increased levels of CRP. Treatment: human immunoglobulin, ASA. The fever stopped on the 2nd day of the therapy. No coronary artery pathology before discharge (day 21), ASA treatment was negligently interrupted. Due to a sudden acute dyspnea, hospitalized for laryngeal stenosis (day 42). Felt relief after hormone treatment. ECG (day 64) showed signs of septal anterior, apical, lateral wall of LV myocardial infarction. Echocardiography: LV dilatation, decrease of LVEF, pericardial effusion; no coronary artery aneurysm. Myocardial scintigraphy: a large LV perfusion defect. MRI: LV aneurysm, LV fibrosis. Cardiac catheterization, coronary angiography: no coronary artery pathology; LV aneurysm. Results: An atypical form of AMI was misinterpreted as laryngeal stenosis in a child with Kawasaki disease without antiplatelet therapy. Current treatment includes ACE inhibitors, B-blockers, and antiplatelet therapy. Echocardiography: increase of LVEF, relief of pericarditis symptoms, no coronary artery pathology. Conclusions: Even with no coronary artery aneurysms after 4–8 weeks, children with Kawasaki disease need cardiac investigation in case of acute conditions similar to atypical MI.