Recurrent systemic inflammatory episodes with coronary artery aneurysms in an adolescent with a history of Kawasaki disease

An adolescent female with a prior diagnosis of Kawasaki disease (KD) presented with systemic inflammatory symptoms, including periorbital swelling, odynophagia and transient fever following initiation of statin therapy. Several months earlier, she experienced a prolonged febrile illness with unilateral neck pain and a desquamating rash, but without classic KD features. Imaging later revealed significant progression of coronary artery aneurysms and thrombus formation, raising concern for KD recurrence. Extensive autoimmune and infectious evaluations were largely unremarkable, apart from a primary Epstein-Barr virus infection. She was treated with intravenous immunoglobulin, corticosteroids and anticoagulation. This case highlights the diagnostic challenges posed by atypical presentations in a condition associated with rare recurrence rates. It underscores the need for long-term cardiovascular surveillance in patients with previous KD, even into adolescence.