Treatment of intravenous immunoglobulin-resistant Kawasaki disease with methotrexate.
OBJECTIVE
To evaluate the effect of low-dose oral methotrexate (MTX) as treatment for patients with Kawasaki disease (KD) resistant to intravenous immunoglobulin (IVIG).


METHODS
The subjects were four patients with KD, aged 8 months to 8 years old, who showed persistent disease after treatment with high-dose IVIG (2 g/kg) and aspirin (100 mg/kg). These patients were re-treated with IVIG and were also treated with IV dexamethasone (0.3 mg/kg). IV dexamethasone induced defervescence in three patients, but fever recurred upon discontinuing the steroid. One patient showed no response to either IVIG or dexamethasone. All patients were subsequently treated weekly with low-dose oral MTX [10 mg/body surface area (BSA)].


RESULTS
MTX treatment resulted in rapid defervescence, improvement in clinical symptoms, and normalization of acute-phase reactants in all patients. There was no progression of coronary artery dilatation and MTX was discontinued with no recurrence of fever. No adverse effects of MTX were observed.


CONCLUSIONS
Low-dose oral MTX is an effective treatment for refractory KD.
Ahn
S Y
SY
Department of Paediatrics, College of Medicine, Yonsei University, Seoul, Korea.
Kim
D S
DS
D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004351:Drug Resistance / Q000187:drug effects*; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever / Q000188:drug therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D009080:Mucocutaneous Lymph Node Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D003907:Dexamethasone; D008727:Methotrexate