A child with Kawasaki disease and genetic warfarin sensitivity from CYP2C9 and VKORC1 gene variants

Abstract

Coronary artery aneurysm (CAA) is a life-threatening complication of Kawasaki disease (KD). Thrombosis in KD with CAA may lead to morbidity and mortality, such as myocardial infarction. Therefore, optimal treatment of children with KD with CAA, is crucial for thromboprophylaxis. Depending on the size of the aneurysm, second antiplatelet agents or anticoagulants may be added to aspirin therapy. We describe a 6-year-old girl who was treated with warfarin after she had developed multiple, long, and medium-sized CAAs in the left anterior descending artery (LAD) and long segments of irregular dilatation and tortuosity in the right coronary artery (RCA). The girl showed a refractory response to conventional treatment of KD and adjunctive steroid therapy, and was at a risk of thrombosis due to turbulent flow inside the CAAs.