Fatal late cardiovascular sequelae of previously unrecognized Kawasaki disease in 12-year-old child

Sep 29, 2026

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Kawasaki disease (KD) is a childhood vasculitis of medium-sized arteries and a leading cause of acquired heart disease. When incomplete KD is missed, long-term sequelae may remain clinically silent for years. This case describes a fatal outcome in a 12-year-old boy whose presumed myocarditis at age five retrospectively met criteria for incomplete KD. He developed mild chest pain at twelve, then rapidly deteriorated to cardiac arrest and death.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

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Abstract

Background

Case presentation

Conclusion

Introduction/background

Case presentation

Fremuthová et al. International Journal of Emergency Medicine (2026) 19:1 [https://doi.org/10.1186/s12245-025-01079-9](https://doi.org/10.1186/s12245-025-01079-9) International Journal of Emergency Medicine CASE REPORT Open Access Fatal late cardiovascular sequelae of previously unrecognized Kawasaki disease in 12-year-old child Tereza Fremuthová 1, Michal Huml 1*, Alexandra Kotková 1, Josef Sýkora 1, Jan Baxa2, Lukáš Hanáček3 and Jiří Fremuth 1 Abstract Background Kawasaki disease (KD), previously termed mucocutaneous lymph node syndrome, is a childhood vasculitis affecting medium-sized arteries and is the leading cause of acquired heart disease in children. It primarily affects children under five years of age. If left untreated, KD can lead to serious cardiovascular complications, particularly coronary artery aneurysms (CAA) and thrombosis. Incomplete KD presents with fewer clinical criteria, making it more difficult to diagnose. Importantly, long-term sequelae such as CAA may remain clinically silent for years. This case highlights the critical need for awareness that even minimal or transient symptoms can be the only warning sign of life-threatening complications in adolescents with a remote history of incomplete or unrecognized KD. Case presentation We describe a fatal case of a 12-year-old boy with a history of presumed myocarditis at age five, which retrospectively fulfilled criteria for incomplete KD but remained undiagnosed. From age five to twelve, he was asymptomatic except for occasional, brief chest tightness. At twelve, he presented with mild chest pain followed by rapid clinical deterioration, cardiac arrest, and death. Post-mortem imaging and autopsy revealed a thrombosed giant aneurysm of the left anterior descending coronary artery, consistent with chronic coronary disease. Conclusion This case illustrates the potentially fatal long-term cardiovascular sequelae of unrecognized and untreated incomplete KD. Early recognition and treatment with IVIG are critical to reduce coronary complications. Healthcare providers must maintain clinical vigilance for patients with a history of KD. Even subtle or transient symptoms in patients with a history of KD should prompt immediate evaluation to prevent fatal outcomes. Keywords Kawasaki disease, Incomplete Kawasaki disease, Coronary aneurysm, Myocardial infarction, Pediatric cardiac arrest, Case report *Correspondence: Michal Huml [humlm@fnplzen.cz](humlm@fnplzen.cz) 1Department of Pediatrics, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic 2Department of Radiology, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic 3Department of Forensic Medicine, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l)icenses/by-nc-nd

FAQs

What long-term complications can occur after unrecognized incomplete Kawasaki disease?

Unrecognized incomplete KD can lead to serious long-term cardiovascular complications, particularly coronary artery aneurysms, which may remain clinically silent for years.

Why was the child’s myocarditis at age five important in retrospect?

The article states that the presumed myocarditis at age five retrospectively fulfilled criteria for incomplete KD, although it remained undiagnosed.

How did the fatal event unfold at age twelve?

At twelve, the patient presented with mild chest pain, followed by rapid clinical deterioration, cardiac arrest, and death; post-mortem findings showed a thrombosed giant aneurysm of the left anterior descending coronary artery.

Sep 29, 2026

Uploaded by Grenda