Background and aims To report two from the 4 patients with Kawasaki disease diagnosed in the last year, an unusual pathology for the Western part of Romania, both of them developing severe coronary complications.

Methods Four patients with Kawasaki disease were admitted in our clinic, 2 infants, 6 and 8 mo and 2 small children, 3 yo, 2 males and 2 females. Kawasaki disease was found in 3 cases and one incomplete disease. Only one patient was diagnosed in the first 10 days of illness. All performed clinical evaluation, ECG, Echocardiography and laboratory tests. Angio CT for coronary artery was used in 2 patients with coronary complications; one performed invasive coronary angiography. Treatment was initiated with intravenous immunoglobuline IGIV and Aspirin.

Results Two patients, 8 mo male and one 3 yo female, diagnosed after the 10^th day of disease developed severe coronary complications, despite of IGIV and Aspirin therapy. The infant developed giant LAD aneurysm with thrombus inside and medium aneurysm of RCA. We associated Clopidogrel 0.2 mg/kg/day to Aspirin, with no result, aneurysm and thrombus increasing. We stopped Clopidogrel and introduced Enoxaparin 0.1 mg/kg/day associated to Aspirin. The difficulty of Enoxaparin administration determined us to change to Warfarin, monitoring the INR. Enoxaparin was slowly reduced, leaving patient only on Warfarin and Aspirin. The giant aneurysm was stable at the 1.2 cm with a thrombus inside of 1 cm. Evolution was good, with slowly reduction of both aneurisms and thrombus. The 3 yo girl developed thickening of the proximal LAD, 0.67 cm, with 0.38 cm of the coronary wall, seen on a distance of 1.45 cm. Echocardiography was the best way to monitor the coronary arteries, compatible with angio CT and coronary angiography.

Conclusions Kawasaki disease needs rapid diagnose and urgent treatment, to prevent coronary complications. When appear and severe, close echocardiography monitoring is needed. It was difficult to choose the best tratment to stop the anurysms and thrombus evolution, because of the lack of the informations from the guideline. It is mandatory to have clear treatment indications in such severe cases. Both patients are well, on treatment and in close monitoring.