{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T19:00:13Z","timestamp":1775934013693,"version":"3.50.1"},"reference-count":13,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2018,11,21]],"date-time":"2018-11-21T00:00:00Z","timestamp":1542758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Kawasaki disease (KD) is a self-limited systemic vasculitis, most often occurring in children 1\u20135 years old. It has a 2% recurrence rate and is associated with coronary aneurysms (CA), which can develop within two weeks of onset. A 25% increased risk is noted in patients who are recalcitrant to treatment. We describe a patient with recurrence of KD three times, approximately four years apart. A 10-year-old female with two previous episodes of KD, at 11 months and five years of age), in which she met five out of five criteria for KD and had no coronary involvement, presented with 15 days of fever, conjunctivitis and mucocutaneous changes. Infectious work-up was negative, and she was diagnosed with incomplete KD meeting three out of five criteria. An echocardiogram (ECHO) on day 12 revealed dilation of the right coronary artery (RCA) and left coronary artery (LCA). Treatment with intravenous immunoglobulin (IVIG) and high-dose aspirin was started at an outside hospital. After transfer, serial ECHOs showed evolving coronary aneurysms, left anterior descending (LAD) z-score + 8.2 and RCA z-score + 4.0. She received 10 mg\/kg infliximab (day 18) and began clopidogrel. A cardiac MRI (day 20) demonstrated progression of the LAD aneurysm, with a z-score + 13, and warfarin was started. To our knowledge, this is the first report of recurrent KD occurring three times at ~5 year intervals.<\/jats:p>","DOI":"10.3390\/children5110155","type":"journal-article","created":{"date-parts":[[2018,11,22]],"date-time":"2018-11-22T09:18:25Z","timestamp":1542878305000},"page":"155","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Recurrent Kawasaki Disease: A Case Report of Three Separate Episodes at &gt;4-Year Intervals"],"prefix":"10.3390","volume":"5","author":[{"given":"Nikita","family":"Goswami","sequence":"first","affiliation":[{"name":"CHLA Pediatric Rheumatology, Children\u2019s Hospital Los Angeles, 4650 Sunset Blvd, Mailstop #60, Los Angeles, CA 90027, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Marzan","sequence":"additional","affiliation":[{"name":"CHLA Pediatric Rheumatology, Children\u2019s Hospital Los Angeles, 4650 Sunset Blvd, Mailstop #60, Los Angeles, CA 90027, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7684-7895","authenticated-orcid":false,"given":"Elizabeth","family":"De Oliveira","sequence":"additional","affiliation":[{"name":"Pacific Pediatric Cardiology, Pacific Pediatric Cardiology Medical Group, Pasadena, CA 91105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon","family":"Wagner-Lees","sequence":"additional","affiliation":[{"name":"CHLA Pediatric Cardiology, Children\u2019s Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacqueline","family":"Szmuszkovicz","sequence":"additional","affiliation":[{"name":"CHLA Pediatric Cardiology, Children\u2019s Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2018,11,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jinf.2013.04.004","article-title":"The role of infection in Kawasaki syndrome","volume":"67","author":"Principi","year":"2013","journal-title":"J. Infect."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e927","DOI":"10.1161\/CIR.0000000000000484","article-title":"Diagnosis, treatment, and long-term management of kawasaki disease: A scientific statement for health professionals from the American heart association","volume":"135","author":"McCrindle","year":"2017","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.semarthrit.2006.02.002","article-title":"Catastrophic Kawasaki disease or juvenile Polyarteritis nodosa?","volume":"35","year":"2006","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1097\/RHU.0000000000000411","article-title":"Recurrent Kawasaki disease: Mind the age, but it does not matter","volume":"22","author":"Kamal","year":"2016","journal-title":"J. Clin. Rheumatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/1546-0096-12-37","article-title":"Kawasaki disease in children and adolescents: Clinical data of Kawasaki patients in a western region (Tyrol) of Austria from 2003\u20132012","volume":"12","author":"Binder","year":"2014","journal-title":"Pediatr. Rheumatol. Online J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e005019","DOI":"10.1099\/jmmcr.0.005019","article-title":"Comprehensive pathogen detection associated with four recurrent episodes of Kawasaki disease in a patient during a single year using next-generation sequencing","volume":"3","author":"Hamada","year":"2016","journal-title":"JMM Case Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2653","DOI":"10.1007\/s00296-012-2485-2","article-title":"A four-time-recurring typical complete Kawasaki syndrome successfully treated with intravenous immunoglobulin: A case report with literature review","volume":"33","author":"Falcini","year":"2013","journal-title":"Rheumatol. Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1177\/0009922817694459","article-title":"Recurrence of fever after initial intravenous immunoglobulin treatment in children with Kawasaki disease","volume":"57","author":"Yoshida","year":"2018","journal-title":"Clin. Pediatr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1111\/ped.12733","article-title":"Recurrent Kawasaki disease: USA and Japan","volume":"57","author":"Maddox","year":"2015","journal-title":"Pediatr. Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1161\/CIRCULATIONAHA.107.690875","article-title":"Coronary artery involvement in children with Kawasaki disease: Risk factors from analysis of serial normalized measurements","volume":"116","author":"McCrindle","year":"2007","journal-title":"Circulation"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.1016\/S0140-6736(13)62298-9","article-title":"Infliximab for intensification of primary therapy for Kawasaki disease: A phase 3 randomised, double-blind, placebo-controlled trial","volume":"383","author":"Tremoulet","year":"2014","journal-title":"Lancet"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1007\/s00247-011-2141-0","article-title":"Adolescent Kawasaki disease: usefulness of 64-slice CT coronary angiography for follow-up investigation","volume":"41","author":"Carbone","year":"2011","journal-title":"Pediatr. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1161\/CIRCIMAGING.112.976969","article-title":"Evaluation of cardiac function by magnetic resonance imaging during the follow-up of patients with Kawasaki disease","volume":"6","author":"Tacke","year":"2013","journal-title":"Circ. Cardiovasc. Imaging"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/5\/11\/155\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:31:03Z","timestamp":1760196663000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/5\/11\/155"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11,21]]},"references-count":13,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2018,11]]}},"alternative-id":["children5110155"],"URL":"https:\/\/doi.org\/10.3390\/children5110155","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,11,21]]}}}