Kawasaki disease is an acute vasculitis of childhood. Which coronary artery complication is the most important cause of late morbidity and mortality?

• A Accelerated atherosclerosis
• B Coronary artery dissection
• C Coronary artery spasm
• D Coronary artery aneurysm with thrombosis ✓

Explanation

Kawasaki disease causes medium-vessel vasculitis, particularly affecting coronary arteries. Aneurysms develop in 20 to 25 percent of untreated children. These aneurysms can thrombose, leading to myocardial infarction and sudden death, which is the most important late complication. IVIG reduces aneurysm formation. Dissection is rare. Spasm occurs acutely but is not the main late problem. Atherosclerosis may accelerate later but thrombosis of aneurysms is the immediate life-threatening complication.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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