Effects of steroid pulse therapy on immunoglobulin-resistant Kawasaki disease.
BACKGROUND
The use of intravenous immunoglobulin (IVIG) is well established as an initial therapy for Kawasaki disease (KD), but treatment for IVIG-resistant KD remains uncertain


OBJECTIVE
To analyse the effects of intravenous methylprednisolone (IVMP) pulse therapy compared with additional IVIG in IVIG-resistant patients.


METHODS
IVMP was administered to patients with KD who had persistent or recurrent fever after a single dose of IVIG, at Juntendo University Hospital and affiliated medical institutions between May 2003 and March 2006. The effectiveness of the treatment and the incidence of coronary lesions in patients who received IVMP and those who received additional IVIG were retrospectively analysed and compared by chart review.


RESULTS
411 patients with KD were treated with a single dose of IVIG. Of the 63 IVIG-resistant patients, 44 were then given IVMP and 19 were given additional IVIG. Treatment was successful in 34 (77%) of the patients who received IVMP and 12 (63%) who received additional IVIG. Five of the 10 patients who did not respond to IVMP and two of the seven who did not respond to additional IVIG developed coronary artery aneurysms. Although fever initially resolved faster in the IVMP-resistant group, there was a delay in fever recurrence, which ultimately delayed the final resolution of fever.


CONCLUSIONS
The findings suggest that IVMP is an effective additional treatment for IVIG-resistant KD. However, there was a tendency for fever to recur later in IVMP-resistant patients, which could potentially delay the therapeutic decision-making process.
Furukawa
T
T
Department of Pediatrics, Juntendo University School of Medicine, 2-1-1 Hongo, Tokyo 113-8421, Japan. tk-furukawa.n@w3.dion.ne.jp
Kishiro
M
M
Akimoto
K
K
Nagata
S
S
Shimizu
T
T
Yamashiro
Y
Y
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003323:Coronary Aneurysm / Q000209:etiology / Q000517:prevention & control; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000188:drug therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D020551:Pulse Therapy, Drug; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin; D008775:Methylprednisolone