An unusual case of recurrent Kawasaki Disease in an 18-year-old woman.

Description of Clinical Presentation: An 18-year-old woman presented with a previous history of Kawasaki disease (diagnosed at 15). Treated with IVIG and IV methylprednisolone. 2 coronary artery aneurysms in LAD 7.8 and 5mm, Coeliac disease and two previous episodes of pericarditis in 2024.


The patient was transferred for ongoing cardiac management due to a worsening of the LAD aneurysm with a clot causing 70% stenosis, acute glandular fever and Strep-A infection.


The Rheumatology multi-disciplinary-team requested an inpatient computed tomography coronary angiogram (CTCA) to assess aneurysm thrombosis and cardiac magnetic resonance (CMR) for pericarditis.

Diagnostic Techniques and Their Most Important Findings: A CTCA demonstrated two LAD Aneurysms (Figure 1, panels A and B) and RCA aneurysm Figure 1. panel C.


Treatment included anticoagulation therapy, steroids and Intravenous immunoglobulin (IVIG).


The patient was subsequently referred to our department for a CMR scan to rule out Pericarditis (and further characterise the extent of the aneurysms).


The CMR demonstrated two coronary aneurysms affecting the mid LAD (Figure 2, panels A and B) with suspicion of thrombotic material within the LAD and further aneurysm in the mid RCA Panel C.


There was normal biventricular size and function with no myocardial infarction, unremarkable pericardial appearance with no significant effusion. These additional diagnostic features of CMR as a tool, are why CMR has the advantage over CTCA in this type of pathology.

Learning Points from this Case: Kawasaki disease is a self-limited systemic paediatric vasculitis with a risk of coronary artery aneurysms (CAA’s). It predominantly affects children < 5 years. Its growing incidence is most recently observed in approximately 20% of patients without treatment¹


CAA’s can be defined as localised dilatation of a coronary artery of more than 1.5 times the adjacent coronary segment. Coronary changes are most commonly seen in the LAD or RCA.


Delayed treatment with IVIG can cause multiple coronary aneurysms, which can be prone to thrombosis ²


The American Heart Association reports a recurrence rate of 2% and usually within the first year ³ making this an unusual case report.

Panel A - Large LAD aneurysm, Panel B - second smaller LAD aneurysm, Panel C – RCA aneurysm
Panel A and Panel B large LAD Thrombotic aneurysm with a second smaller aneurysm. Panel C-RCA aneurysm.