Congenital anomalies of coronary artery misdiagnosed as coronary dilatations in Kawasaki disease: A clinical predicament

Table 1 Characteristics of the patients with Kawasaki disease and congenital coronary artery anomalies

Characteristics	Case 1	Case 2	Case 3
Age of presentation/sex	11 years/male	3.3 years/male	4 months/female
Clinical presentation	Complete KD	Incomplete KD	Incomplete KD
Haemoglobin (g/L)	105	97	102
Total leukocyte counts (× 109/L)	22.4	6	7.6
Differential leukocyte counts	N62L24M08E06	N67L20M7E06	N51L36M10E3
Platelet counts at presentation (× 109/L)	0.49	4.46	6.1
ESR (mm/hour)	54	29
CRP (mg/L) (n < 6 mg/L)	229	45.63	107
NT-proBNP (n < 125 pg/mL)	39000	1318	2649
Serum albumin (g/dL)	1.7	4.1	3.6
ALT (IU/L)	21	17	951
AST (U/L)	39	37	534
Blood urea (mg/dL)	219		32
Serum creatinine (mg/dL)	5.5		0.11
Urine microscopy	10-12 RBCs/hpf, 5-6 WBCs/hpf
Others	Skin biopsy- features of small vessel vasculitis. Cerebrospinal fluid analysis: Cells- nil, Sugar-88 mg/dL, Protein- 31 mg/dL, Gram stain and Indian ink negative, culture sterile
2DE findings	LCA: 10 mm (+ 14.7 z)	LCA: 3.34 mm (+ 3.44 Z); LAD: 1.5 mm (- 0.17 Z); LCx: 1.53 mm (0.09 Z) RCA: 0.99 mm (-2.06 Z)	LCA: Not visible. Proximal LAD: 1.48 mm (+ 1.59 Z). Mid LAD: 2.01 mm (+ 3.42 Z). RCA: 2.15 mm (+ 4.03Z)
Treatment received	IVIg (2 g/kg); aspirin (3-5 mg/kg/day)	IVIg (2 g/kg); aspirin (3-5 mg/kg/day); infliximab (5mg/kg)	IVIg (2 g/kg); aspirin (3-5 mg/kg/day)
CTCA findings	Separate origins of the LAD and LCx from left sinus with no LCA	Single coronary artery arising from left sinus with left dominant circulation. Anomalous origin of RCA from common trunk left sinus with interarterial course. No evidence of any stenosis/ectasia/aneurysm was seen	Anomalous origin of LCA from MPA c/w ALCAPA with dilated LAD and LCX. Diffusely dilated RCA (likely due to ALCAPA). No aneurysm was seen in the coronary arteries

KD: Kawasaki disease; ESR: Erythrocyte sedimentation rate; CRP: C-reactive protein; NT-proBNP: N-terminal pro-brain-type natriuretic peptide; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; RBC: Red blood cells; WBC: White blood cells; 2DE: 2dimentional echocardiography; CTCA: Computed tomography coronary angiography; LCA: Left coronary artery; RCA: Right coronary artery; LCx: Left circumflex artery; LAD: Left anterior descending; MPA: Main pulmonary artery; ALCAPA: Anomalous origin of left coronary artery from the main pulmonary artery.