Title : Previously undiagnosed Kawasaki Disease presenting as severe premature multi vessel coronary artery disease in a young adult.
Abstract:
Background:
Acute coronary syndrome (ACS) in young adults is uncommon and should prompt consideration of non-atherosclerotic causes of coronary artery disease. Kawasaki disease (KD) is a childhood vasculitis associated with late coronary complications, including aneurysm formation, stenosis and thrombosis, which may present in adulthood.¹?²
Case Presentation:
A man in his early twenties presented with a 3-day history of exertional chest pain and dyspnoea. Troponin was elevated, electrocardiography demonstrated inferior T-wave inversion, and echocardiography showed mild left ventricular systolic dysfunction. Coronary angiography demonstrated severe triple-vessel disease, with chronic total occlusion of the mid left anterior descending artery, proximal left circumflex artery and proximal right coronary artery.
The severity and distribution of coronary disease were considered disproportionate to his conventional cardiovascular risk profile. He had a history of previous tobacco smoking and significant exposure to high-volume vaping products. Although emerging evidence suggests adverse cardiovascular effects associated with e-cigarette use, its contribution to severe premature coronary artery disease remains uncertain.³
Further investigations excluded vasculitis, familial hypercholesterolaemia, sitosterolaemia and other inflammatory arteriopathies. A history of prolonged febrile illness during childhood subsequently raised suspicion of previously undiagnosed KD. Intraoperative findings during coronary artery bypass grafting demonstrated appearances suggestive of an arteritic rather than conventional atherosclerotic process, further supporting this diagnosis.
Conclusion:
This case highlights the importance of considering non-atherosclerotic causes of ACS in young adults presenting with severe multivessel coronary disease. A detailed childhood history may provide important diagnostic clues to previously unrecognised KD, which can result in significant coronary complications years after the acute illness. Recognition of atypical causes of premature coronary artery disease is important to guide appropriate investigation, revascularisation and long-term cardiovascular follow-up.
