Acute Myocardial Infarction Caused by Transient Coronary Vasospasm in a Child With Kawasaki Disease and No Coronary Aneurysms

We report a 15-month old girl with acute myocardial infarction 3 months after treatment for Kawasaki disease (KD); she had no coronary aneurysms. In the first 2 months after KD, she had normal electrocardiograms (ECGs) and echocardiograms that showed mildly dilated coronary arteries. At 3 months, she was asymptomatic but developed ECG changes of anteroseptal MI and increased troponin levels. Echocardiogram showed regional wall-motion abnormalities and decreased left ventricular function. She was admitted and treated with heparin and nitroglycerin drips. Repeat echocardiogram at 24 h showed resolution of wall-motion abnormalities and improved function. Cardiac catheterization showed normal coronary arteries. Her troponin levels normalized within 36 h, and she was discharged on low molecular-weight heparin and aspirin. She has done well since discharge with normal ECGs and echocardiograms during the following 2.5 years. Although coronary vasospasm has been described in young adults with history of KD, we report the first such presentation in a child. This underscores the fact that vascular endothelial dysfunction occurs despite absence of overt coronary aneurysms in patients with KD as well as the need for close follow-up.