A 4-year-old boy presents with high fever (39.8°C) for 6 days refractory to antipyretics. Physical examination demonstrates bilateral non-exudative bulbar conjunctival injection, cracked red strawberry lips, an erythematous polymorphous rash over the trunk, cervical lymphadenopathy (measuring 1.8 cm), and erythema of the palms and soles with indurative edema. What is the most significant long-term complication prevented by early treatment with IVIG and Aspirin?

Answer and explanation

Correct answer: C. Coronary artery aneurysms

  1. Step 1: The child meets the diagnostic criteria for Kawasaki disease (fever >= 5 days plus at least 4 of 5 classic clinical criteria).
  2. Step 2: The primary morbidity and mortality in Kawasaki disease stems from coronary artery vasculitis leading to coronary artery aneurysms, thrombosis, or myocardial infarction in up to 25% of untreated children.
  3. Step 3: Administration of intravenous immunoglobulin (IVIG 2 g/kg) and high-dose aspirin within the first 10 days of fever reduces the incidence of coronary aneurysms to under 4-5%.
Answer
Coronary artery aneurysms.
Why not the others: 'Aortic valve regurgitation' is typical of syphilitic aortitis or Marfan syndrome; 'Dilated cardiomyopathy with LVOT obstruction' describes hypertrophic cardiomyopathy variants; 'Infective endocarditis' is a bacterial infection of damaged valves, not an autoimmune medium-vessel vasculitis complication.

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