Giant coronary and systemic aneurysms in an infant with missed Kawasaki disease and the role of apixaban

Infants with Kawasaki disease (KD) are at an increased risk of coronary artery aneurysms. Systemic artery aneurysms (SAA) have been sparingly reported in KD and can pose unique therapeutic challenges. In this report, we describe a nine-month-old male infant who presented with giant coronary and bilateral axillary artery aneurysms as a sequela of missed KD. He was treated with infliximab and corticosteroids, along with anticoagulation with apixaban. This case highlights the challenges involved in managing SAA in patients with KD and emphasizes the importance of anticoagulation to prevent thrombotic complications. We also discuss the use of apixaban as a potential treatment option for these patients. •Management of systemic artery aneuryms (SAA) in Kawasaki disease (KD) is a complex endevour.•SAA in KD need a multidisciplinary approach and careful consideration of anticoagulation.•Apixaban can be considered in KD associated SAA and the index case highlights the safety of this approach.