Case report: death of a 2-year-old girl with postmortem diagnosis of a rare coronary artery vasculitis typical for Kawasaki syndrome

Abstract

Coronary artery autoimmune vasculitis (Kawasaki syndrome) is at least in Germany a very rare condition, that typically manifests in childhood. The symptoms are often unspecific and complications with vascular aneurysms, thrombosis and myocardial infarction can occur. Multiple cases of Kawasaki-like symptoms in children with positive SARS-CoV‑2 test results have been reported during the course of the COVID-19 pandemic the past year. This case study reports on a 2-year-old child who had fever over 6 days and after a temporary improvement, died within 1 day (pre-COVID19 era). The autopsy showed autoimmune vasculitis of the right and left main coronary artery consistent with Kawasaki syndrome with aneurysm formation, acute thrombosis and myocardial infarction. In the case of macroscopically conspicuous dilated and/or thrombosed coronary arteries and/or myocardial infarction in children, a Kawasaki syndrome should be excluded in addition to other differential diagnoses.