A rare cause of coronary artery aneurysms with possible underlying Kawasaki disease

Coronary artery aneurysms, rare lesions of Kawasaki disease (KD) and coronary atherosclerosis, are associated with severe cardiac complications. We herein describe an interesting case of coronary artery aneurysms due to exertional angina with possible underlying KD. A 26-year-old man without traditional risk factors for atherosclerosis presented with exertional chest pain and a positive exercise electrocardiogram stress test. Coronary angiography revealed total obstruction of the right coronary artery at the proximal portion, and the proximal left anterior descending artery contained a large spherical cavity filled with contrast agent; thus, the diagnosis of coronary artery aneurysms was confirmed. This was a typical coronary lesion suggestive of KD, and coronary artery bypass grafting was recommended. The diagnosis of KD may be ignored or missed in childhood, and significant cardiovascular damage may remain silent until adulthood, when severe coronary artery stenosis or thrombosis results in angina or acute myocardial infarction. Thus, to promote timely treatment and reduce morbidity and mortality, antecedent KD should be considered in the presence of angina pectoris or acute myocardial infarction in young patients without traditional risk factors for atherosclerosis.