Fatal late cardiovascular sequelae
of previously unrecognized Kawasaki disease
in 12-year-old child

Fatal late cardiovascular sequelae
of previously unrecognized Kawasaki disease
in 12-year-old child

Kawasaki disease, Incomplete Kawasaki disease, Coronary aneurysm, Myocardial infarction, Pediatric
cardiac arrest, Case report

Abstract
Background Kawasaki disease (KD), previously termed mucocutaneous lymph node syndrome, is a childhood
vasculitis affecting medium-sized arteries and is the leading cause of acquired heart disease in children. It primarily
affects children under five years of age. If left untreated, KD can lead to serious cardiovascular complications,
particularly coronary artery aneurysms (CAA) and thrombosis. Incomplete KD presents with fewer clinical criteria,
making it more difficult to diagnose. Importantly, long-term sequelae such as CAA may remain clinically silent for
years. This case highlights the critical need for awareness that even minimal or transient symptoms can be the only
warning sign of life-threatening complications in adolescents with a remote history of incomplete or unrecognized
KD.
Case presentation We describe a fatal case of a 12-year-old boy with a history of presumed myocarditis at age five,
which retrospectively fulfilled criteria for incomplete KD but remained undiagnosed. From age five to twelve, he was
asymptomatic except for occasional, brief chest tightness. At twelve, he presented with mild chest pain followed by
rapid clinical deterioration, cardiac arrest, and death. Post-mortem imaging and autopsy revealed a thrombosed giant
aneurysm of the left anterior descending coronary artery, consistent with chronic coronary disease.
Conclusion This case illustrates the potentially fatal long-term cardiovascular sequelae of unrecognized and
untreated incomplete KD. Early recognition and treatment with IVIG are critical to reduce coronary complications.
Healthcare providers must maintain clinical vigilance for patients with a history of KD. Even subtle or transient
symptoms in patients with a history of KD should prompt immediate evaluation to prevent fatal outcomes.
Keywords Kawasaki disease, Incomplete Kawasaki disease, Coronary aneurysm, Myocardial infarction, Pediatric
cardiac arrest, Case report

Tereza Fremuthová1

, Michal Huml1*, Alexandra Kotková1

, Josef Sýkora1
, Jan Baxa2
, Lukáš Hanáček3

and Jiří Fremuth1

https://doi.org/10.1186/s12245-025-01079-9

2026

peri irawan

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