A case of severe Kawasaki disease: from multiple coronary aneurysms to interleukin-1 inhibition

Introduction Kawasaki disease (KD) is the leading cause of acquired heart disease in children, posing a significant risk of coronary aneurysms. We present a clinical case of rapidly progressing coronary aneurysms that developed despite timely treatment with intravenous immunoglobulin (IVIG). Case presentation A 3-year-old child with a recent KD diagnosis, treated with IVIG and corticosteroids, was referred to a tertiary hospital for suspected coronary artery dilatation. On arrival, transthoracic echocardiography (TTE) revealed a giant aneurysm of the right coronary artery with a diameter of 5 mm. At the bifurcation of the left main coronary artery, an aneurysm with a maximum diameter of approximately 8 mm was identified, with suspected thrombotic material observed within its lumen. The anterior descending artery demonstrated a maximum diameter of 4 mm. Intravenous heparin was started. Cardiac computed tomography was performed and confirmed the coronary aneurysms, without evidence of intraluminal thrombi. Aspirin and clopidogrel were also started due to the high risk of coronary thrombosis. Interleukin-1 receptor antagonist therapy was initiated to promote vascular remodeling, and steroid therapy was discontinued. During the follow-up, coronary aneurysms remained stable in size, and serial echocardiography TTE demonstrated normal dimensions of the coronary artery. Conclusion The current clinical case describes a challenging and severe course of KD with rapidly progressing coronary aneurysms despite early standard treatment, with a favorable response to interleukin-1 inhibitors, underscoring the need for tailored therapies based on the patient inflammatory profile.