PDF(Pubmed)
Abstract：
BACKGROUND: Kawasaki disease (KD) is a type of vasculitis in which giant coronary artery aneurysms (CAAs) can occur. There are no specific guidelines for managing giant CAAs that develop quickly and are at risk of rupture. Regarding cardiovascular drugs, only beta-blockers are formally recommended in the acute phase of KD.
METHODS: A 6-month-old male patient with multiresistant Kawasaki disease and giant CAAs that continued to enlarge after controlling systemic inflammation was examined. The patient required three doses of intravenous immunoglobulin, methylprednisolone pulses, and anakinra and infliximab to normalize systemic inflammation. Due to the rapid increment of aneurysms\' dimensions and the risk of rupture, we introduced anticoagulant therapy and propranolol plus captopril, and titration doses were introduced according to a tolerated decrease in heart rate and arterial pressure. CAAs increment stabilized and slowly reduced their dimensions.
CONCLUSIONS: The authors describe an atypical case of multiresistant KD with giant rapidly increasing CAAs even after controlling systemic inflammation. The introduction of a beta-blocker and an angiotensin-converting enzyme (ACE) inhibitor was demonstrated to be useful for stabilizing giant CAAs growth and reducing the potential risk of rupture.
METHODS: A 6-month-old male patient with multiresistant Kawasaki disease and giant CAAs that continued to enlarge after controlling systemic inflammation was examined. The patient required three doses of intravenous immunoglobulin, methylprednisolone pulses, and anakinra and infliximab to normalize systemic inflammation. Due to the rapid increment of aneurysms\' dimensions and the risk of rupture, we introduced anticoagulant therapy and propranolol plus captopril, and titration doses were introduced according to a tolerated decrease in heart rate and arterial pressure. CAAs increment stabilized and slowly reduced their dimensions.
CONCLUSIONS: The authors describe an atypical case of multiresistant KD with giant rapidly increasing CAAs even after controlling systemic inflammation. The introduction of a beta-blocker and an angiotensin-converting enzyme (ACE) inhibitor was demonstrated to be useful for stabilizing giant CAAs growth and reducing the potential risk of rupture.
摘要：
背景：川崎病（KD）是一种血管炎，可发生巨大的冠状动脉瘤（CAA）。没有管理快速发展且有破裂风险的巨型CAA的具体指南。关于心血管药物，仅在KD急性期正式推荐β受体阻滞剂。
方法：检查了一名6个月大的男性患者，患有多重耐药川崎病和巨大的CAA，在控制全身炎症后继续扩大。病人需要三剂静脉注射免疫球蛋白,甲基强的松龙脉冲，和阿纳金拉和英夫利昔单抗使全身炎症正常化。由于动脉瘤的尺寸和破裂的风险迅速增加，我们介绍了抗凝治疗和普萘洛尔加卡托普利，根据心率和动脉压的耐受下降引入滴定剂量。CAAs增量稳定并缓慢减小其尺寸。
结论：作者描述了一个非典型的多重耐药KD病例，即使在控制了全身炎症后，其CAA也在迅速增加。β受体阻滞剂和血管紧张素转换酶（ACE）抑制剂的引入被证明可用于稳定巨大的CAAs生长并降低潜在的破裂风险。
方法：检查了一名6个月大的男性患者，患有多重耐药川崎病和巨大的CAA，在控制全身炎症后继续扩大。病人需要三剂静脉注射免疫球蛋白,甲基强的松龙脉冲，和阿纳金拉和英夫利昔单抗使全身炎症正常化。由于动脉瘤的尺寸和破裂的风险迅速增加，我们介绍了抗凝治疗和普萘洛尔加卡托普利，根据心率和动脉压的耐受下降引入滴定剂量。CAAs增量稳定并缓慢减小其尺寸。
结论：作者描述了一个非典型的多重耐药KD病例，即使在控制了全身炎症后，其CAA也在迅速增加。β受体阻滞剂和血管紧张素转换酶（ACE）抑制剂的引入被证明可用于稳定巨大的CAAs生长并降低潜在的破裂风险。
