# Recurrent Kawasaki Disease in a Three-Year-Old Boy: A Case Report and Review of the Literature

## TL;DR

A three-year-old boy experienced a second case of Kawasaki disease, which showed more severe heart involvement and treatment resistance compared to his first episode.

## Contribution

This case report highlights the clinical importance and variable presentation of recurrent Kawasaki disease.

## Key findings

- The patient showed coronary artery ectasia during the recurrence, which later regressed.
- The recurrence demonstrated greater cardiac involvement and relative IVIG resistance.
- Prompt anti-inflammatory therapy and close cardiology follow-up are crucial for managing recurrent KD.

## Abstract

Kawasaki disease (KD) is an acute medium-vessel vasculitis and the leading cause of acquired heart disease in children in developed countries. Recurrence is uncommon but clinically important because subsequent episodes may carry a heightened risk of coronary artery involvement and treatment resistance. We report a three-year-old boy with recurrent KD approximately 13 months after an initial, uncomplicated KD episode at 23 months of age. Echocardiography demonstrated coronary artery ectasia. He was diagnosed and treated with intravenous immunoglobulin (IVIG) on day 3 of illness and required steroid treatment in addition. Coronary artery ectasia has regressed on subsequent follow-ups. This case highlights that recurrent KD can present with variable clinical criteria yet demonstrate greater cardiac involvement and relative IVIG resistance compared with the index episode. Clinicians should maintain vigilance for recurrence, promptly institute anti-inflammatory therapy, and ensure close cardiology follow-up to mitigate coronary complications.