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Extensive coronary artery thrombosis in a paediatric patient with Kawasaki disease: a case report
Tilbe Kasap1, Inga Voges2, Katy Rinne2
1Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105 Kiel, Germany.
Insights
Kawasaki disease (KD) can lead to coronary artery aneurysms (CAAs) and thrombosis. This case highlights severe coronary thrombosis despite early treatment, suggesting delayed oral anticoagulation may increase risks in pediatric patients.
Area of Science:
- Cardiology
- Pediatric Rheumatology
- Vascular Biology
Background:
- Kawasaki disease (KD) is a pediatric vasculitis affecting coronary arteries, potentially causing aneurysms (CAAs).
- CAAs increase risks of thrombosis, myocardial ischemia, and severe cardiac outcomes.
- Timely antiplatelet and anticoagulation therapy is crucial for managing KD complications.
Observation:
- A 12-year-old patient with KD developed CAAs in two coronary arteries.
- Despite initial IVIG and aspirin, extensive coronary thrombosis occurred.
- Antithrombotic therapy was initiated after CAA diagnosis.
Findings:
- Severe coronary thrombosis developed despite standard antiplatelet and anticoagulant therapy.
- Late initiation of oral anticoagulation may be linked to the severe thrombosis.
- High-quality imaging provides educational value for pediatric coronary artery complications.
Implications:
- This case underscores the potential for severe thrombosis in KD patients, even with early treatment.
- Emphasizes the critical importance of timely and potentially aggressive antithrombotic strategies, including oral anticoagulation, in managing KD-associated CAAs.
- Highlights the need for continued research into optimal management protocols for pediatric vasculitis with cardiac involvement.
Background:
Kawasaki disease (KD) is a paediatric multi-system vasculitis. Mainly, the coronary arteries become affected due to acute inflammation and formation of coronary artery aneurysms (CAAs) may occur. As the size of the CAA increases, so does the risk of clinical complications and serious cardiac outcomes. These patients may experience life-threatening thrombotic coronary artery occlusion and myocardial ischaemia unless antiplatelet and anticoagulation therapy is not initiated in a timely manner.1.
Case Summary:
This case report presents a 12-year-old patient with KD who developed CAAs in two coronary arteries despite initial administration of intravenous immunoglobulins and acetylsalicylic acid, followed by extensive thrombosis of both coronary arteries, although antithrombotic therapy was started after the diagnosis of CAAs.
Discussion:
Our case is notable because of the severity of the clinical manifestation despite the administration of antiplatelet agents and anticoagulants. It could be speculated that the development of coronary thrombosis in this case might be strongly correlated with the late initiation of oral anticoagulation. The high-quality images of the affected coronary arteries in such a young patient could be of educational value.
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