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. Conclusion: BCG 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.<Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry nameend="c2" namest="c1"> 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. </entry> </row> <row> <entry nameend="c2" namest="c1"> 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. </entry> </row> </tbody> </tgroup> </Table>

Coronary artery abnormalities in Kawasaki disease with BCG site reactivation

期刊论文
发表日期：

2025年12月27日

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Rakesh Kumar Pilania,
Abarna Thangaraj,
Sathish Loganathan,
Dev Desai,
Aparna KV,
Vaishali Thakur,
Manpreet Dhaliwal,
Saniya Sharma,
Ankur Kumar Jindal,
Pandiarajan Vignesh,
Deepti Suri,
Amit Rawat,
Manphool Singhal,
Surjit Singh

摘要

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. Conclusion: BCG 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.