Yoshikawa Hideki, Nomura Yuichi, Masuda Kiminori, Hazeki Daisuke, Yotsumoto Keiko, Arata Michiko, Kamenosono Akira, Yanagi Sadamitsu, Yoshinaga Masao, Kawano Yoshifumi
Division of Pediatrics, Graduate School of Medical and Dental sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
Circ J. 2006 Feb;70(2):202-5. doi: 10.1253/circj.70.202.
Myocarditis frequently occurs in the acute phase of Kawasaki syndrome (KS), and a few severe cases have been reported. Four cases of myocarditis in KS required additional catecholamine treatment because of severe left ventricular dysfunction (LVD).
Three cases were relatively older children and 2 cases were complicated with encephalopathy. All 4 developed coronary artery abnormalities during convalescence. There was 1 case of LVD because of prolonged severe inflammation prior to administration of intravenous immunoglobulin (IVIG). The remaining 3 patients had normal values for ejection fraction before the administration of IVIG but decreased values (42-51%) and increased C-reactive protein levels after IVIG administration. These cases demonstrate an association between myocarditis in KS and severe or worsened inflammation.
Even with prior normal echocardiography, careful observation of cardiac function may be necessary for patients with KS, especially older children, when inflammation deteriorates after administration of IVIG.
心肌炎常发生于川崎病（KS）急性期，已有少数重症病例报道。4例KS合并心肌炎患者因严重左心室功能不全（LVD）需要额外的儿茶酚胺治疗。
3例为年龄稍大儿童，2例合并脑病。所有4例在恢复期均出现冠状动脉异常。有1例因在静脉注射免疫球蛋白（IVIG）前严重炎症持续时间长而出现LVD。其余3例患者在IVIG给药前射血分数正常，但给药后射血分数降低（42 - 51%）且C反应蛋白水平升高。这些病例表明KS合并心肌炎与严重或恶化的炎症之间存在关联。
即使先前超声心动图检查正常，对于KS患者，尤其是年龄稍大儿童，在IVIG给药后炎症恶化时，可能仍需仔细观察心脏功能。
