ArticleEuropean journal of pediatrics2025
Coronary artery abnormalities in Kawasaki disease with BCG site reactivation.
Article in European journal of pediatrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BCG site reactivation is reported in Kawasaki disease (KD). However, it is not a part of American Heart Association (AHA) guidelines. Records of all KD patients admitted between January 2009 and June 2024 were reviewed. Patients with BCG site reactivation were analysed. Among 1206 KD patients, 19 had BCG site reactivation (1.57%). Median age at diagnosis was 7 months. Twelve out of 19 patients (63.2%) were infants. Echocardiography showed coronary artery abnormalities (CAAs) in 11 (57.9%; aneurysms in 10, dilatation in 1) and myocarditis in 1. CAAs developed in 83.3% (10/12) of infants with KD and BCG site reactivation, compared to 37.2% (73/196) of infants who did not have BCG reactivation (p = 0.006; odds ratio: 8.4). All patients received intravenous immunoglobulin (IVIg) and aspirin. Infliximab was used for IVIg resistance in 4 (21.1%) and for primary intensification in 6 (31.6%). Cumulative follow-up was 386 patient-months. Seven patients with CAAs showed regression over 12 months.
conclusionBCG site reactivation is uncommon in children with KD at our centre. It primarily occurs in infants with KD. There is a eightfold higher risk of CAAs among infants with KD and BCG site reactivation, than in those without BCG reactivation. WHAT IS KNOWN: • BCG site reactivation is a recognised clinical feature of Kawasaki disease. • The role of BCG site reactivation as a predictor of coronary artery abnormalities (CAAs) has not been clearly established. WHAT IS NEW: • At our centre, BCG site reactivation was observed in 1.58% of KD patients, predominantly in infancy. • Infants with BCG site reactivation had an eightfold higher risk of CAAs (83.3% vs 37.2%). • BCG reactivation may serve as a simple bedside marker to identify infants at risk of severe KD who may require closer monitoring and timely/intensified therapy.
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