Patients diagnosed with Kawasaki disease before the fifth day of illness have a higher risk of coronary artery aneurysm.
BACKGROUND
A fever lasting for at least 5 days is an essential characteristic of the original diagnostic criteria of Kawasaki disease (KD). However, it is not difficult for an experienced physician to confirm the diagnosis of KD before the fifth day of fever. The aim of this study is to investigate the effect of intravenous gamma globulin therapy (IVGG) in KD initiated before the fifth day of illness.


METHODS
A total of 125 patients treated with IVGGwere divided into group A (IVGG was initiated before the fifth day of illness, n= 46) and group B (IVGG was initiated at the fifth day or after, n= 79). Patients' characteristics,laboratory findings, treatments and outcomes were compared between the groups.


RESULTS
White blood cell count value, C-reactive protein and Harada's score showed no difference between the groups. A significantly higher average value of alanine aminotransferase(ALT) was observed in group A. Although the treatments were identical in both groups, the average duration of fever from the initial day of IVGG in group A was significantly longer than in group B. The incidence of aneurysm in group A was significantly higher than that in group B. Stepwise regression analysis using aneurysm as a dependent variable revealed that group A and ALT were significant.


CONCLUSIONS
Patients diagnosed with KD before the fifth day of illness showed a poor response to IVGG. This observation might be related to high ALT values. Further examination concerning the modification of treatment in such patients is necessary.
Department of Pediatrics,Faculty of Medicine, Kagoshima University, Kagoshima, Japan. uichi@m2.kufm.kagoshima-u.ac.jp
Yuichi
Y
Nomura
Kiminori
K
Masuda
Masao
M
Yoshinaga
Koji
K
Sameshima
Koichiro
K
Miyata
D002648:Child; D002675:Child, Preschool; D003323:Coronary Aneurysm / Q000209:etiology*; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D013997:Time Factors
D016756:Immunoglobulins, Intravenous