Cardiac arrest as initial presentation of Kawasaki disease with giant coronary aneurysms: A case report and review of literature

Abstract

BACKGROUND

Kawasaki disease (KD) is an acute systemic vasculitis in young children that may cause coronary aneurysms, thrombosis, myocardial infarction, and sudden death if diagnosis is delayed.

CASE SUMMARY

We report a 19-month-old male patient who presented after 25 days of progressive illness culminating in sudden cardiac arrest. Initial episodes of fever, cough, and rash were misdiagnosed as viral infection and pneumonia, delaying recognition. On admission following prolonged resuscitation, he was comatose with severe metabolic acidosis, multiorgan dysfunction, and periungual desquamation. Echocardiography demonstrated giant bilateral coronary aneurysms with right coronary artery thrombosis, consistent with KD complicated by myocardial infarction. Management included mechanical ventilation, high-dose vasopressors, intravenous immunoglobulin, corticosteroids, anticoagulation, and antibiotics. Continuous renal replacement therapy, targeted temperature management, and therapeutic plasma exchange were employed to control cytokine storm and organ failure. The patient stabilized hemodynamically, was extubated by day 12, and subsequently transferred for cardiology care. Follow-up imaging confirmed persistent aneurysms without thrombosis, preserved cardiac function, and favorable neurological recovery.

CONCLUSION

This case underscores the challenges of recognizing atypical KD and highlights the importance of early suspicion, rapid resuscitation, and multimodal therapies, including Continuous renal replacement therapy and therapeutic plasma exchange, in improving survival and neurological outcomes.

Keywords: Kawasaki disease; Cardiac arrest; Coronary artery aneurysm; Continuous renal replacement therapy; Therapeutic plasma exchange; Viet Nam; Case report

Core Tip: Kawasaki disease (KD) is a childhood illness that can damage the heart if not recognized early. We describe a 19-month-old boy who developed fever, cough, and rash for almost a month, but was repeatedly treated as having infections. He suddenly went into cardiac arrest and was found to have severe heart vessel damage with clots from undiagnosed KD. He required prolonged resuscitation, advanced life support, and multiple treatments including cooling therapy, combined interventions of continuous renal replacement and plasma exchange. Remarkably, he recovered with good heart and brain function, showing the importance of early recognition and aggressive care in severe KD.