Kawasaki disease is an acute vasculitis leading to coronary aneurysms in children; atypical Kawasaki is common among infants < 6 months. CMV has been shown to be associated with vascular diseases. We describe a 4-month-old female with atypical Kawasaki and coronary aneurysms during primary CMV infection.
On admission, the infant had had 5 days of fever and bilateral conjunctivitis. She was tachycardic but without cardiac failure. Laboratory was significant for elevated inflammatory markers. Her blood, urine and CSF cultures were negative; her chest radiograph showed pneumonia. She had an unremarkable ECG and abdominal ultrasound. Echocardiography showed normal contraction and a small pericardial effusion.
On day 8, her bloodwork revealed thrombocytosis, hypoalbuminemia and elevated liver enzymes. Atypical Kawasaki was suspected and treated by IVIG and aspirin with ensuing defervescence and decrease in inflammatory markers.
Her repeat echocardiogram on day 9 showed small fusiform aneurysms of right coronary and circumflex arteries.
CMV-PCR was positive in the patient’s nasopharynx, blood and urine. Subsequent blood samples showed an increasing CMV-DNA viral load. Maternal CMV serology revealed past infection, supporting primary CMV infection in the infant.
To the best of our knowledge, only two children with atypical Kawasaki and concomitant primary CMV have been reported. Notably, all developed early coronary aneurisms within 10 days. Previous studies show thrombi, vasculitis, atherosclerosis and aneurisms in patients with CMV. Kawasaki with concomitant CMV may predispose patients to more severe and earlier vascular sequelae. Moreover, it may be prudent to perform an echocardiogram on infants with severe CMV disease.
