Late diagnosis of Kawasaki disease with major cardiovascular complications: a case report

BACKGROUND: Kawasaki disease (KD) is an acute systemic vasculitis syndrome, mostly targeting children under 5 years old. If untreated, coronary artery abnormalities develop to approximately one out of four patients who suffered from KD. As KD might be easily missed in childhood, managing cardiovascular complications might become a real challenge at an advanced age. CASE SUMMARY: A 25-year-old woman was presented to a skying resort hospital with discomfort in chest, shortness of breath, cold sweat, and dizziness after skiing. Based on increased troponin level and ECG findings, the specialists diagnosed myocarditis and initiated treatment with non-steroidal anti-inflammatory drugs. After the symptoms recurred in half a year, there was a need for further clarification of the diagnosis of myocarditis. The patient received a comprehensive cardiac imaging evaluation at Vilnius University Santaros Clinic to differentiate the cause of the recurrent chest pains. Coronary artery computed tomography revealed presence of aneurysm with wall calcification in left anterior descending artery S6—10 mm in diameter and aneurysm of circumflex artery S11—7 mm in diameter as well as occlusion of calcified right coronary artery. After taking a detailed medical history, a presumption about a former case of KD has been made. DISCUSSION: Coronary artery aneurysm is a cardiovascular sequelae of KD if it is left untreated. Due to atypical presentation, it might be overlooked, while the key of successful KD management is an early diagnosis and therapy.