Late Sequela of Kawasaki’s Disease: Optical Coherence Tomographic Finding

Case Description. A 24-year-old male without coronary risk factors came to our office for recent-onset exertional angina associated with shortness of breath. His medical history was notable for Kawasaki’s disease at the age of two. A stress test showed anterior ischemia. Subsequently, he underwent computed tomography (Figure 1) and coronary angiography, which revealed a calcified tubular narrowing of the proximal left anterior descending (LAD) and chronic total occlusion in the proximal right coronary artery (RCA), with bridge collaterals (Figures 2A and B). Optical coherence tomography (OCT) (LightLab Imaging™, Westford, Massachusetts) of the proximal left anterior descending (LAD) artery lesion showed circumferential “egg-shell” calcification and thickening of the intima without typical changes of atherosclerosis (Figures 3A and B).1 Discussion. In Kawasaki’s disease, arterial lesions involve necrotizing panarteritis with intimal thickening and destruction of the media.2-4 In this patient with a history of Kawasaki’s disease, granulation and scar formation in the media had evolved into circumferential “egg-shell”-type calcification. This is the first in vivo demonstration of the coronary arterial changes using optical coherence tomography as a late sequela of Kawasaki’s disease. From Kyung Hee University Hospital, Seoul, Korea, and †Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Disclosure: Dr. Jang reports that he has received research grants, consulting fees and speaker honoraria from LightLab Imaging. Manuscript submitted June 24, 2009, provisional acceptance given July 13, 2009, final version accepted July 20, 2009. Address for correspondence: Professor Ik-Kyung Jang, MD, Harvard Medical School, Cardiology, Massachusetts General Hospital, 55 Fruit Street, Gray/Bigelow 800, Boston, MA 02114. E-mail: ijang@partners.org

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