# Extensive coronary artery thrombosis in a paediatric patient with Kawasaki disease: a case report

## TL;DR

A 12-year-old child with Kawasaki disease developed severe coronary artery thrombosis despite receiving standard treatments, highlighting the risks of delayed anticoagulation.

## Contribution

This case highlights the rare severity of coronary thrombosis in KD and the potential impact of delayed anticoagulation.

## Key findings

- The patient developed coronary artery aneurysms despite initial treatment with immunoglobulins and aspirin.
- Extensive thrombosis occurred in both coronary arteries after a delay in starting oral anticoagulation.
- High-quality imaging of the coronary arteries in a young patient provides educational value for clinicians.

## Abstract

Kawasaki disease (KD) is a paediatric multi-system vasculitis. Mainly, the coronary arteries become affected due to acute inflammation and formation of coronary artery aneurysms (CAAs) may occur. As the size of the CAA increases, so does the risk of clinical complications and serious cardiac outcomes. These patients may experience life-threatening thrombotic coronary artery occlusion and myocardial ischaemia unless antiplatelet and anticoagulation therapy is not initiated in a timely manner.1

This case report presents a 12-year-old patient with KD who developed CAAs in two coronary arteries despite initial administration of intravenous immunoglobulins and acetylsalicylic acid, followed by extensive thrombosis of both coronary arteries, although antithrombotic therapy was started after the diagnosis of CAAs.

Our case is notable because of the severity of the clinical manifestation despite the administration of antiplatelet agents and anticoagulants. It could be speculated that the development of coronary thrombosis in this case might be strongly correlated with the late initiation of oral anticoagulation. The high-quality images of the affected coronary arteries in such a young patient could be of educational value.