Recurrent Kawasaki Disease Complicated by Giant Coronary Aneurysms Showing Only Two Clinical Manifestations

Abstract

We herein report a recurrent case of Kawasaki disease (KD) complicated by giant coronary aneurysms that developed only fever and slight conjunctival injection. A 3-year-old boy developed a cough and fever for one day and was referred to us because of a strong inflammatory reaction. He had a history of complete KD previously, and was treated with intravenous immunoglobulin therapy (IVIG) 7 months ago with no coronary arterial lesion afterward. However, this time, he had a cough and chest X-ray showed consolidation; therefore, we suspected bacterial pneumoniae and started antibiotic therapy. Since this failed to reduce his fever, we administered another antibiotic drug, which was also ineffective. Echocardiography was performed on day 7 from onset and revealed bilateral coronary arterial aneurysms, the appearance of which resembled a string of beads. Based on this finding, he was diagnosed with incomplete KD and IVIG, cyclosporine A, and aspirin were administered. Fever improved 12 hours later, but recurred at 36 hours. Due to the possibility of the further expansion of coronary arterial aneurysms, he was transferred to another hospital for plasma exchange.

Patients with recurrent KD are known to be at risk of coronary arterial lesions. However, since the present case only exhibited 2 main manifestations, making an accurate diagnosis was not straightforward. Therefore, the recurrence of KD needs to be considered in children with fever and a history of KD.