Abstract 16776: Persistent Fevers and Diffuse Rash in a 27 Year-Old Female With Heart Failure
A 27 year old Asian female with history of intra-uterine device placement two years prior presented to the hospital with one week of high-grade fevers, chills, nausea, vomiting, mild diffuse abdominal pain, arthralgias, malaise, and a diffuse rash. On presentation, she was febrile and tachycardic. Examination revealed mildly injected conjunctiva bilaterally and tender submandibular lymphadenopathy. A petechial rash was visible in the creases of her bilateral upper and lower extremities, forearms, palms, and torso. A macular rash with areas of confluence was noted on anterior neck, back, and groin. Laboratory values revealed marked leukocytosis, markedly elevated ferritin level, and proteinuria. After three days of hospitalization, she demonstrated cardiogenic shock requiring intubation, dobutamine, norepinephrine, and furosemide. Transthoracic echocardiogram demonstrated severely reduced left ventricular systolic function, moderately reduced right ventricular systolic function, moderate mitral regurgitation, and a small pericardial effusion. She was initiated on an empiric three day course of intravenous immunoglobulin. She demonstrated rapid recovery and was extubated after only a few days. She had persistent high-grade fevers for several consecutive days despite negative cultures and broad-spectrum antibiotic use, and she demonstrated desquamation of her fingertips. Coronary angiogram revealed large aneurysmal dilatation of all three coronary arteries, confirming the diagnosis of adult-onset Kawasaki disease. She was treated with aspirin, plavix, steroids, and doxycycline. Computed tomography angiography performed after discharge demonstrated improved aneurysmal dilatation of the proximal left anterior descending artery with normal caliber left circumflex artery and right coronary artery. Transthoracic echocardiogram demonstrated markedly improved left ventricular function, and resolution of the mitral regurgitation, pericardial effusion, and right ventricular dysfunction. This case illustrates a typical presentation of an uncommon life-threatening condition in a highly atypical patient age range.
- © 2013 by American Heart Association, Inc.