CASE REPORT Multiple Mirror-Image Peripheral Arterial Aneurysms in Kawasaki Disease Manraj K. S. Heran • Aaron Hockley Received: 26 November 2010 / Accepted: 2 February 2011 / Published online: 17 February 2011 Ó Springer Science+Business Media, LLC 2011 Abstract We present the case of a 5-year-old boy diag- nosed with Kawasaki disease at 10 months of age who developed fusiform aneurysms of the coronary arteries as well as a previously undescribed pattern of mirror-image peripheral arterial aneurysms. These aneurysms were diagnosed on conventional angiography of the aortoiliac circulation and the bilateral upper extremity circulation. Keywords Kawasaki disease Á Mirror aneurysms Á Angiography Introduction Kawasaki disease (KD) is an immune-mediated vasculitis affecting primarily medium-sized vessels. It is character- ized by persistent fever (refractory to most antipyretics), nonpurulent conjunctivitis, cracked red lips or ‘‘strawberry tongue,’’ erythematous macular rash, peripheral extremity edema, and cervical lymphadenopathy. KD is infamous for its most well-known complication of coronary artery aneurysms (CAAs), which occur in B20% of untreated patients [1, 7, 8]. However, because it is a systemic vasculitis, it can also cause aneurysms of the noncoronary (peripheral) arterial circulation, although these are less frequent, occurring in only approximately 2% of untreated patients [2]. Here, we report a unique case of a 5-year-old boy who had a previously unreported finding of multiple peripheral arterial aneurysms in a mirror-image pattern across the sagittal plane, in addition to coronary arterial aneurysms, in the setting of known KD. Case Report At 10 months of age, our patient presented to a peripheral hospital with a 1-day history of lethargy, poor feeding, fever, and maculopapular rash on his chest, back, lips, and nose. He was noted to have bilateral nonpurulent con- junctivitis, pharyngeal erythema, and nonbilious, non- bloody vomiting. On day 2, he developed diarrhea. His illness was attributed to a viral infection, and he was dis- charged home on day 5. On day 10, he returned to hospital with persistent symptoms, now including fever, maculo- papular rash, cracked lips, pharyngeal erythema, and con- junctivitis. He was subsequently diagnosed as having KD. The patient was then started on the standard therapy of intravenous immunoglobulin (IVIG) and oral aspirin. His symptoms were refractory to two courses of IVIG therapy. He was then transferred to our paediatric tertiary center for continuing care. He was started on salvage therapy of high- dose pulsed methylprednisolone (30 mcg/kg), which pro- duced satisfactory regression of clinical symptoms. Echocardiogram during his admission at our institution showed fusiform aneurysms of the left and right coronary arteries, with both branches (left anterior descending and circumflex) of the left coronary artery being involved. After resolution of his clinical symptoms, he was dis- charged on high-dose oral prednisone (10 mg po BID), high-dose oral aspirin (80 mg/kg/d), and enoxaparin (1 mg/kg BID) administered subcutaneously. M. K. S. Heran (&) Department of Radiology, British Columbia’s Children’s Hospital, Vancouver, BC V6H 3V4, Canada e-mail: mheran@cw.bc.ca A. Hockley British Columbia’s Children’s Hospital, Vancouver, BC V6H 3V4, Canada 123 Pediatr Cardiol (2011) 32:670–673 DOI 10.1007/s00246-011-9916-9