Rare systemic artery lesions due to Kawasaki disease diagnosed in adults: a review of the literature on abdominal aortic aneurysms and renovascular hypertension

We report two adult patients who had rare systemic artery lesions with a history of Kawasaki disease, with a review of the literature. A 39-year-old male with Kawasaki disease at the age of 2 months underwent coronary artery bypass grafting to the right coronary artery and left anterior descending artery because of coronary artery stenoses. In the screening by thoracic-abdominal CT before the operation, calcification of the distal abdominal aorta was detected, and an abdominal aortic aneurysm with stenosis was diagnosed. He had been asymptomatic, and there were no differences in his extremities' blood pressure. Although a slight dilatation of the distal abdominal aorta had existed in his aortogram at 2 years 9 months old, the abnormal finding had been unnoticed. A 26-year-old female with coronary artery bypass grafting at the age of 23 months had hypertension. A stenosis of the orifice at the right renal artery was detected by two-dimensional echocardiography and a magnetic resonance angiogram. Her hypertension in adulthood was suspected to result from her renal artery stenosis, which acute Kawasaki vasculitis underlies. Although coronary artery lesions in both patients were diagnosed in their childhood, systemic artery lesions were not realised until adulthood. Because abdominal aortic aneurysms and renal artery stenosis are extremely rare, they were not recognised as systemic artery lesions caused by Kawasaki disease. Their lesions can occur in patients with severe acute vasculitis at a significantly younger age, less than 6 months. Systemic artery lesions in such adult patients must be carefully evaluated.