Delayed Development of a Giant Coronary Aneurysm and Complete Resolution in a 4-Month-Old Infant with Incomplete Kawasaki’s Disease

Objectives: Kawasaki’s disease (KD) is a pediatric vasculitis of unknown origin. Its main cardiac complication is the development of coronary artery aneurysms (CAA). Infants <12 months of age are more likely to have an incomplete presentation.

Methods: A 4-month-old previously healthy Caucasian boy was admitted to the hospital with fever and poor feeding. He was diagnosed urinary tract infection and treated accordingly. The inflammation persisted and he developed thrombocytosis and a maculopapular rash. Consecutive echocardiography on day 10 unveiled coronary artery dilation (right 4, left 3.5 mm). He was treated with intravenous immunoglobulin (2 g/kg KG/d), cortisone and high-dose aspirin. Within 48 hours, the inflammation resumed and coronary dilation remained stable. He was discharged under low dose aspirin. Echocardiography after 4 and 12 weeks showed only minimally increased size of the right CA (5 mm). The clinical course was uneventful. Six months after the disease onset a giant aneurysm of the RCA (9 mm × 10 mm) was found and confirmed on angiography. Coumadin therapy was started. The aneurysm gradually decreased in size. Echo and angiography proved complete resolution after 3 years. Coumadin therapy was stopped, aspirin continued.

Conclusion: Young children with incomplete KD may develop giant coronary aneurysms late after the disease onset. Spontaneous resolution of the aneurysm is possible; however, the mechanism remains unclear.