Clinical Practice and Cases in Emergency Medicine

Introduction: Kawasaki disease is a vasculitis most commonly affecting children under five years of age but can also occur in older children and adults. When not sufficiently treated, Kawasaki disease can lead to cardiac complications such as myocarditis and coronary artery aneurysms, with aneurysms being the most serious long-term complication as it poses a risk for acute coronary syndrome.

Case Report: A 19-year-old with remote history of Kawasaki disease presented to the emergency department with chest pain, diaphoresis, and emesis after being struck in the chest by another player during a basketball game. Despite his young age and reported mild musculoskeletal trauma, an electrocardiogram and troponin were ordered. Electrocardiogram findings were concerning for ischemia, and troponin was elevated, confirming myocardial infarction and prompting a cardiology consult. Urgent percutaneous coronary intervention of the occluded aneurysm with balloon angioplasty resulted in significantly improved distal blood flow.

Conclusions: Kawasaki disease is widely recognized as a cause of cardiac complications in childhood, but the risk does not end there. Adults with a history of childhood Kawasaki disease remain at risk for complications of coronary artery aneurysm, even when they received appropriate medical treatment. Thrombosis or dissection of a coronary artery aneurysm can lead to acute coronary syndrome in otherwise healthy individuals. Therefore, emergency physicians must maintain a high level of suspicion for cardiac complications in both children and adults with a history of Kawasaki disease. In this case, prompt diagnosis and intervention were essential to achieving the best possible outcome.