title: Initial intravenous gammaglobulin treatment failure in Kawasaki disease.
abstract: OBJECTIVE
  To determine initial intravenous gammaglobulin (IVIG) treatment failures in Kawasaki disease (KD) and to report the outcome of retreatment and our use of pulse intravenous (IV) methylprednisolone and cyclophosphamide in patients with persistent KD.
  
  
  METHODS
  Retrospective analysis of the treatment and response of children with KD over 3 years.
  
  
  RESULTS
  Fifty (77%) of 65 patients completely responded to a single treatment with IVIG (2 g/kg). Fifteen patients (23%) required retreatment; 10 patients fully responded but 5 had persistent disease (3 developed coronary aneurysms and 4 developed coronary artery thrombosis). Four of these 5 patients with persistent disease were treated with pulse IV methylprednisolone and 2 were also treated with IV cyclophosphamide. There was no progression of coronary aneurysms and no deaths. No initial patient characteristics predicted IVIG treatment failure or the development of coronary aneurysms.
  
  
  CONCLUSIONS
  Nearly 23% of patients with KD may require retreatment and 8% may develop coronary aneurysm. Additional antiinflammatory therapy, such as IV methylprednisolone and IV cyclophosphamide, may be helpful in treating persistent KD.
authors.affiliation: Department of Pediatrics, University of Washington; and Children's Hospital and Regional Medical Center, Seattle, Washington 98105-0371, USA. cwallace@u.washington.edu
authors.forename: C A
authors.initials: CA
authors.lastname: Wallace
authors.forename: J W
authors.initials: JW
authors.lastname: French
authors.forename: S J
authors.initials: SJ
authors.lastname: Kahn
authors.forename: D D
authors.initials: DD
authors.lastname: Sherry
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D003323:Coronary Aneurysm / Q000209:etiology; D003328:Coronary Thrombosis / Q000209:etiology; D003520:Cyclophosphamide / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008775:Methylprednisolone / Q000627:therapeutic use*; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D001241:Aspirin; D008775:Methylprednisolone