Triple-Vessel Coronary Involvement and Giant Aneurysm in a 6-Year-Old Boy With Kawasaki Disease: A Case Report Publisher Pubmed



Majnoon M T ; Rajabi M M ; Hemati S ; Ziaee V ; Rafati Navaei M ; Gharib B
Source: BMC Cardiovascular Disorders Published:2026

Abstract

Background: Kawasaki disease (KD) is an acute systemic vasculitis of unknown origin. It represents one of the most important causes of acquired heart disease in the pediatric population. Coronary artery involvement is the most serious complication and may result in aneurysm formation and thrombosis. However, simultaneous involvement of all three major coronary arteries and giant aneurysm is rare and usually indicates severe disease. Case presentation: This case report describes a 6-year-old boy with KD who developed progressive involvement of all three major coronary arteries despite standard treatment. The patient received intravenous immunoglobulin (IVIG) on the eighth day of illness, after which the fever resolved. However, follow-up imaging revealed a giant aneurysm of the left anterior descending (LAD) artery along with progressive dilation of the left circumflex (LCX) and right coronary arteries (RCA). During the clinical course, mural thrombosis developed within the LAD aneurysm, and the patient was readmitted for further management. Intensive medical therapy was initiated, including corticosteroids, cyclosporine, infliximab, anticoagulation, and antiplatelet agents. Coronary angiography demonstrated partial patency of the LAD with preserved distal run-off; therefore, surgical intervention was deferred. During follow-up, improvement of the aneurysms in the RCA and LCX was observed, whereas the LAD aneurysm and associated thrombosis persisted. Despite these findings, the patient remained clinically stable with preserved cardiac function and normal daily activities. Conclusion: This case report documented a rare occurrence of triple-vessel coronary involvement with a giant LAD aneurysm and thrombosis in KD. This study highlighted that, despite severe coronary abnormalities and resistance to standard treatment, favorable clinical outcomes may still be achieved with medical therapy and close long-term follow-up. © The Author(s) 2026.