All That Childhood Coronary Artery Aneurysms Are Not Kawasaki Disease!

Excerpt

To the Editor: A 10-y-old boy presented with high grade hectic pattern fever (104 °F) and left hypochondrial abdominal pain for 5 d. On examination, moderate hepatosplenomegaly (6 cm below costal margin) without significant lymphadenopathy was observed. Hemoglobin was 8.7 g/dl, platelet counts of 47 × 10³/μL and total leucocyte count (TLC) was 3.75 × 10³/μL with 40% neutrophils in complete hemogram. Peripheral smear was non-contributory. Blood and urine culture, evaluation for tropical infections like typhus fever, dengue and malaria, serological tests for Epstein-Barr virus and parvo virus and polymerase chain reaction for cytomegalovirus were all non-contributory. Erythrocyte sedimentation rate was 70 mm/h and C-reactive protein was 6 mg/dl. The fever was persistent and the TLC had decreased to 0.18 × 10³/μL with absent blast cells in smear examination. Bone marrow evaluation showed: 93% periodic acid Schiff positive lymphoid blasts and pre-B cell acute lymphoblastic leukemia (ALL). Echocardiogram performed on day 10 of fever for pre-chemotherapy cardiac evaluation showed left main coronary artery (LMCA) aneurysm (2.5 Z-score) with normal cardiac contractility (Fig. 1).

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