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

Sep 28, 2026

Kawasaki disease (KD) is an acute systemic vasculitis in young children that can lead to coronary aneurysms, thrombosis, myocardial infarction, and sudden death when recognition is delayed. This report describes a 19-month-old boy whose progressive illness culminated in sudden cardiac arrest after misdiagnosis as viral infection and pneumonia, causing prolonged resuscitation and multiorgan dysfunction. Imaging showed giant bilateral coronary aneurysms with thrombosis, treated with multimodal intensive therapy.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Abstract

Background

Case summary

Conclusion

Core tip

Introduction

| W | J | C | C | World Journal of
Clinical Cases | | --- | --- | --- | --- | --- | Submit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Clin Cases 2025 December 26; 13(36): 114472 DOI: 10.12998/wjcc.v13.i36.114472 ISSN 2307-8960 (online) CASE REPORT Cardiac arrest as initial presentation of Kawasaki disease with giant coronary aneurysms: A case report and review of literature Dat Minh-Tan Truong, Liem Thanh Bui, Tam Khiet Nguyen, Hieu Trong Pham, Bao Quoc Vo, Thanh Tat Nguyen Specialty type: Critical care medicine Provenance and peer review: Invited article; Externally peer reviewed. Peer-review model: Single blind Peer-review report’s classification Scientific Quality: Grade C Novelty: Grade D Creativity or Innovation: Grade D Scientific Significance: Grade C P-Reviewer: Truyen TTTT, MD, Researcher, United States Received: September 22, 2025 Revised: October 20, 2025 Accepted: December 11, 2025 Published online: December 26, 2025 Processing time: 96 Days and 17.4 Hours Dat Minh-Tan Truong, Liem Thanh Bui, Hieu Trong Pham, Bao Quoc Vo, Department of Intensive Care Unit, Children’s Hospital 2, Ho Chi Minh City 700000, Viet Nam Liem Thanh Bui, Department of Pediatrics, University of Medicine and Pharmacy, Ho Chi Minh City 700000, Viet Nam Tam Khiet Nguyen, Department of Cardiology, Children’s Hospital 2, Ho Chi Minh City 700000, Viet Nam Thanh Tat Nguyen, Department of Infectious Diseases, Children’s Hospital 2, Ho Chi Minh City 700000, Viet Nam Co-first authors: Dat Minh-Tan Truong and Liem Thanh Bui. Corresponding author: Thanh Tat Nguyen, MD, PhD, Senior Researcher, Department of Infectious Diseases, Children’s Hospital 2, Ly Tu Trong, Ho Chi Minh City 700000, Viet Nam. [thanhhonor@gmail.com](thanhhonor@gmail.com) 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 per- WJCC [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 26, 2025 Volume 13 Issue 36 Truong DMT et al. Cardiac arrest from Kawasaki coronary aneurysms sistent 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. Key Words: Kawasaki disease; Cardiac arrest; Coronary artery aneurysm; Continuous renal replacement therapy; Therapeutic plasma exchange; Viet Nam; Case report ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved. Core Tip: Kawasaki disease (KD) is a childhood illness that can damage the heart if not recog

FAQs

Why was Kawasaki disease initially missed in this case?

Early fever, cough, and rash were repeatedly treated as viral infection and pneumonia, delaying recognition of KD.

What did echocardiography show after admission?

Echocardiography demonstrated giant bilateral coronary aneurysms with right coronary artery thrombosis, consistent with KD complicated by myocardial infarction.

What treatments were used to manage severe KD with cardiac arrest?

Management included mechanical ventilation, high-dose vasopressors, intravenous immunoglobulin, corticosteroids, anticoagulation, antibiotics, continuous renal replacement therapy, targeted temperature management, and therapeutic plasma exchange.

Sep 28, 2026

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