Dear Sir

AFRICA 37 with medical therapy and referred for coronary artery bypass grafting. discussion KD is a febrile disorder of unknown cause with multiple systemic manifestations, affecting primarily infants and young children. 4 First described in Japan by Kawasaki in 1967 as acute mucocutaneous lymph node syndrome, it has been reported with increasing frequency around the world. Involvement of the heart with acute myocarditis and coronary angiitis occurs in 25 to 50% of the patients during the acute phase, accounting for most of the mortality. However, 50% of the aneurysms regress spontaneously over a one-to two-year period, and therefore adult ischaemic heart disease secondary to KD is infrequent and occurs mostly in young adults. 4 Obtaining a history of childhood Kawasaki disease is quite difficult because the diagnosis of acute KD is based on clinical criteria only, without specific laboratory testing, and therefore requires a high index of suspicion. In young adults, diagnosis is based on typical features in two-dimensional echocardiography and coronary arteriography. The former consists of local wall motion abnormalities as a result of prior MIs and ectasia or frank aneurysms of the proximal coronary arteries. Echocardiography is particularly helpful in the paediatric population, both for initial diagnosis and for long-term follow up. Coronary arteriography typically reveals multivessel aneu-rysmal disease alternating with segmental stenoses, coronary ectasia, calcifications, rich collateral circulation, and varying degrees of left ventricular dysfunction as a sequela of multiple MIs or myocarditis, or both. Conclusion We believe that our patient had KD rather than atherosclerotic CAE, for the following reasons. (1) He had extensive triple-vessel disease at a very early age. He was a non-smoker without any other risk factors for atherosclerotic coronary artery disease (CAD). This would favour KD because patients with CAE have the typical risk profile of atherosclerotic CAD. (2) Our patient had ectasia involving all three vessels, which is rare in athero-sclerotic CAE, but typical of KD. In our patient, echocardiog-raphy failed to reveal features of KD because the very proximal left main and right coronary arteries were spared. This is not uncommon in KD. 4,6 However, coronary arteriography clearly demonstrated the typical findings of KD. Adult coronary artery disease probably due to childhood Kawasaki disease. Aortocoronary bypass grating in a child with coronary artery obstruction due to mucocutaneous lymph node syndrome. Report of a case. Aneurysmal coronary artery disease. Atherosclerotic coronary artery ectasia or adult mucocutaneous lymph node syndrome. The review …