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Coronary artery abnormalities in Kawasaki disease with BCG site reactivation

Rakesh Kumar Pilania1, Abarna Thangaraj2, Sathish Loganathan2

  • 1Pediatric Allergy and Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. kumarpilania007@gmail.com.

European Journal of Pediatrics
|January 19, 2026
PubMed

Insights

BCG site reactivation in Kawasaki disease (KD) is uncommon, primarily affecting infants. Infants with KD and BCG site reactivation face an eightfold higher risk of coronary artery abnormalities, suggesting its use as a risk marker.

Area of Science:

  • Pediatrics
  • Immunology
  • Cardiology

Background:

  • BCG site reactivation is a recognized clinical feature of Kawasaki disease (KD).
  • The predictive role of BCG site reactivation for coronary artery abnormalities (CAAs) remains unclear.
  • BCG site reactivation is not currently included in American Heart Association (AHA) guidelines for KD management.

Purpose of the Study:

  • To investigate the incidence and clinical significance of BCG site reactivation in Kawasaki disease patients.
  • To determine if BCG site reactivation is associated with an increased risk of coronary artery abnormalities (CAAs) in KD.
  • To evaluate BCG site reactivation as a potential bedside marker for identifying high-risk infants with KD.

Main Methods:

  • Retrospective review of all KD patients admitted between January 2009 and June 2024.
  • Analysis of patients diagnosed with BCG site reactivation.
  • Echocardiography used to assess for coronary artery abnormalities (CAAs).

Main Results:

  • BCG site reactivation occurred in 1.57% (19/1206) of KD patients.
  • The majority of patients with BCG site reactivation were infants (63.2%, 12/19).
  • Infants with KD and BCG site reactivation had an eightfold higher risk of CAAs (83.3%) compared to those without reactivation (37.2%).

Conclusions:

  • BCG site reactivation is an infrequent but significant finding in Kawasaki disease, predominantly seen in infants.
  • BCG site reactivation is a strong predictor of coronary artery abnormalities in infants with KD.
  • BCG reactivation may serve as a valuable bedside marker for identifying infants at high risk for severe KD complications.

Keywords:
Acquired heart diseaseBCGChildrenCoronary artery abnormalities (CAAs)InfantsKawasaki disease (KD)

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