Table 1.
Patient Demographics, Clinical Features, and Management Before and After Diagnosis of Giant Coronary Aneurysms
| Categories | Patient 1 | Patient 2 | Patient 3 |
|---|---|---|---|
| Age | 4 mo | 2 y | 12 y |
| Sex | Male | Male | Female |
| Race or ethnicity | African American | African American | Hispanic or Latino |
| Medical history | 33 wk premature, twin | Negative | Obesity |
| Met CDC case definition of MIS-C(9) | Yes | Yes | Yes |
| Age <21 y | Yes | Yes | Yes |
| Fever | Yes | Yes | Yes |
| Inflammation (laboratory) | Yes | Yes | Yes |
| Severe illness (hospitalized) | Yes | Yes | Yes |
| Multiorgan involvement (>2) | Dermatologic, gastrointestinal, respiratory, cardiac, hematologic | Dermatologic, gastrointestinal, respiratory, cardiac, renal, hematologic | Dermatologic, neurologic, respiratory, cardiac, hematologic |
| Positive SARS-CoV-2 test | PCR and serology | Serology | Serology |
| Met criteria for KD | Incomplete | Complete | Incomplete |
| Fever >5 d | Yes | Yes | Yes |
| Conjunctivitis | Yes | Yes | Yes |
| Extremity changes | Yes | Yes | Yes |
| Rash | Yes | Yes | Yes |
| Oral mucosal changes | No | Yes | No |
| Cervical lymphadenopathy | No | No | No |
| Laboratory criteriaa | 5/6 | N/A | 5/6 |
| CRP >3mg/dLa | Yes | N/A | Yes |
| ESR >40 mm/ha | No | N/A | Yes |
| Giant CAA diagnosis | Day of illness 21 | Day of illness 31 | Day of illness 20 |
| Maximum z-score | +31.4 (LAD) | +17 (RCA) | +13.8 (LAD) |
| Therapy pre–giant CAA diagnosis | Dexamethasone, remdesivir | IVIG, IVMP/prednisolone Aspirin, enoxaparin |
IVIG, IVMP/prednisone, anakinra Aspirin, enoxaparin |
| Therapy post–giant CAA diagnosis | IVIG, IVMP/prednisolone, infliximab Aspirin, enoxaparin, clopidogrel |
IVMP/prednisolone, infliximab Aspirin, enoxaparin, clopidogrel |
Tocilizumab, anakinra, IVMP/prednisone Aspirin, enoxaparin, warfarin |
| Coronary thrombosis | Suspected | No | No |
| Follow-up | |||
| Time to last encounter | 3 mo | 3 mo | 6 mo |
| Coronary aneurysm size | Decreased, except for mid-RCA (increased) | Decreased | Decreased |
| Ongoing therapy | Prednisolone taper, aspirin, enoxaparin, clopidogrel | Prednisolone taper, aspirin, enoxaparin, clopidogrel | Aspirin, warfarin |
CAA = coronary artery aneurysms; CDC = Centers for Disease Control and Prevention; CRP = C-reactive protein; ESR = sedimentation rate; IVIG = intravenous immunoglobulin, IVMP = intravenous methylprednisolone; KD = Kawasaki disease; LAD = left anterior descending coronary artery; MIS-C = multisystem inflammatory syndrome in children; N/A = not applicable: PCR = polymerase chain reaction; RCA = right coronary artery; SARS-CoV-2 = severe acute respiratory syndrome-coronavirus-2.
a
Supportive of Kawasaki disease diagnosis if criteria for incomplete Kawasaki disease were met.