ABC | Volume 113, Nº6, December 2019

Original Article Coronary Artery Dilation in Children with Febrile Exanthematous Illness without Criteria for Kawasaki Disease Jesus Reyna, 1 Luz Marina Reyes, 2 Lorenzo Reyes, 3 Freya Helena Campos, 4 Patricia Meza, 5 Alfredo Lagunas, 6 Carla Contreras, 6 Ana Elena Limón 5 Hospital Central Sur de Alta Especialidad – Pediatria, 1 Ciudad de México – México Hospital Central Sur Pemex – Pediatria, 2 Ciudad de México – México Hospital Central Sur Pemex – Cardiología, 3 Ciudad de México – México Hospital Central Sur Pemex – Alergología, 4 Ciudad de México – México HCSAE Pemex, 5 Ciudad de México – México INSP México, 6 Ciudad de México – México Mailing Address: Jesus Reyna • Hospital Central Sur de Alta Especialidad – Pediatria - Periferico Sur Delgación Tlapan Mexico D. F. 14140 – México E-mail: jesusreynaf@gmail.com Manuscript received October 05, 2018, revised manuscript December 27, 2018, accepted March 10, 2019 DOI: 10.5935/abc.20190191 Abstract Background: Coronary dilatation is the most important complication of Kawasaki disease (KD) and, in addition to some clinical characteristics, is common to KD and febrile exanthematous illnesses (FEIs). Objective: To assess whether children with FEI, who do not meet the criteria for KD, have changes in coronary arteries dimensions. Methods: Echocardiography was performed within the first two weeks of the disease in patients < 10 years with fever and exanthema without other KD criteria. To make a comparison with KD patients, we reviewed the echocardiograms and medical records of patients with a diagnosis of KD of the last five years. Coronary ectasia was assessed using Z scores of coronary arteries. The means of the dimensions of the coronary arteries were compared with a z test and a level of significance of 0.05 was adopted. Results: A total of 34 patients were included, 22 (64.7%) with FEI, and 12(35.2%) with a diagnosis of KD. Using the Z scores of coronary artery, a dilation of any of the coronary artery branches was observed in six (27.2%) patients with FEI. Conclusions: An important percentage of patients with FEI has coronary artery dilation. (Arq Bras Cardiol. 2019; 113(6):1114-1118) Keywords: Child; Coronary Disease; Evanthema; Fever; Kawasali Disease; Mucocutaneous Lymph Node Syndrome; Echocardiography/methods. Introduction Up to some years ago, exanthema and fever in children were diagnosed as one of the diseases of the complex known as febrile exanthematous illnesses (FEI), including measles, rubella and scarlet fever. Thus, it was considered that, in most cases, symptoms would disappear by symptomatic treatment. 1 As vaccination schedule became universal, the epidemiology of FEIs has changed in a way that Kawasaki disease (KD), which was once an exception among these diseases, has become the primary illness to be considered in face of clinical signs including persistent fever and exanthema. Coronary abnormalities are the most serious complications of KD. 2,3 Besides fever and exanthema, FEIs and KD share other clinical characteristics, such as conjunctival injection, swollen lymph nodes, and, in some cases, desquamation and swelling of the limbs, which supports the suspicion of KD in any of its forms. 4,5 It is paradoxical that, when the clinical presentation of incomplete KD is confused with self-limited diseases such as FEIs, the occurrence of a serious cardiovascular disease as a complication may be neglected. 6 Studies have established that FEIs and KD have in common pathophysiologic mechanisms and clinical signs, 7 and therefore, some infectious agents have been proposed as responsible for causing KD. This implies that patients that have been diagnosed with FEIs without meeting the criteria for KD could develop coronary abnormalities. 7,8 These are considered an uncommon cause of cardiac disease among pediatric patients. However, the ensuing mortality, in some cases, makes them relevant in clinical practice. 9 Given all of this, we intend to assess whether children with febrile illness who do not meet the criteria for KD have changes in coronary arteries dimensions. Methods In a cross-sectional study, we included patients under 10 years of age with a diagnosis of FEI in the pediatric outpatient settings 1114