Progressive coronary aneurysms in Kawasaki disease: A case report and long-term follow-up

Kawasaki disease (KD) is a vasculitis that primarily affects children under 5 years of age with coronary artery aneurysms being a significant complication that can lead to long-term cardiovascular risks such as thrombosis and stenosis. We report the case of a 13-year-old boy who was diagnosed with KD after presenting with fever, skin lesions, and conjunctivitis. Cardiac imaging revealed aneurysms of the intraventricular artery, the circumflex artery, and the right coronary artery. Despite initial treatment with intravenous immunoglobulin, aspirin, low molecular weight heparin, and subsequent acenocoumarol therapy, the patient experienced progressive thrombosis of the intraventricular artery aneurysm over 3 years. Investigations revealed a hypercoagulable state due to hyperactive Von Willebrand factor, prompting treatment adjustments that resulted in gradual improvement of the thrombosis. This case underscores the critical need for early imaging, timely diagnosis, and long-term monitoring of KD patients, as coronary aneurysms may persist or progress despite prompt therapy. Rigorous follow-up, tailored anticoagulation strategies, and regular imaging are essential to minimize the risk of life-threatening cardiovascular complications.