A Case of Kawasaki Disease with Re-dilatation of the Coronary Artery Five Years after the Onset

We experienced a case of Kawasaki disease with re-dilatation of coronary artery aneurysm five years after the onset. [Patient profile] The patient is a 12-year-old boy. He suffered from Kawasaki disease at the age of four years. Intravenous gamma-globulin (IVGG) therapy with 300 mg/kg/day was administered for 5 days, and additional IVGG with 1g/kg/day was administered furthermore. However, in spite of IVGG therapy, the aneurysms were developed on the both coronary arteries, which were confirmed by the cardiac catheterization one year later. (AHA Committee Report: Segment 2: two aneurysms; 4.8mm, 5.0mm in diameter, Segment 6: 4,3mm, Segment 11: 4.1mm). Thereafter, the coronary aneurysm on LAD regressed gradually. We depicted this regression of LAD aneurysm by the echocardiography at 4 years after the onset. (Segment 6: 2.4mm in diameter). However, further follow-up echocardiography revealed re-dilatation of the aneurysm on the same region of LAD one year later. (Segment 6: 7.4mm in diameter). We also confirmed this re-dilatation of the aneurysm without stenotic lesions by cardiac catheterization. [Discussion] There have been reported that the regressed aneurysms sometimes develop to the stenotic lesions late after the onset. However, there are a few reports in which a newly developed aneurysm emerged late after the onset of Kawasaki disease. [Conclusions] Re-dilatation of the regressed aneurysm is a very unique clinical course as a long-term Kawasaki disease. While the mechanism of the re-dilatation of this patient is still un-known, we must be careful to follow him up.