title: Intravenous immune globulin plus corticosteroids in refractory Kawasaki disease.
abstract: BACKGROUND
  The aim of the present study was to investigate the efficacy of i.v. immune globulin (IVIG) therapy combined with corticosteroids for additional treatment of acute Kawasaki disease (KD) unresponsive to initial IVIG treatment.
  
  
  METHODS
  In 50 prospective KD patients, six IVIG non-responders without clinical improvement within 24-48 h after completion of initial IVIG, received 2 g/kg IVIG concurrently with 2 mg/kg i.v. prednisolone sodium succinate (PSL) until normalization of C-reactive protein level. Treatment was then changed to oral PSL, which was tapered over time. Clinical and coronary artery lesion (CAL) outcomes were compared with those of 13 IVIG non-responders who received additional heterogeneous therapies in 125 retrospective KD patients. In addition, the scoring system of Kobayashi et al. for prediction of non-responsiveness to initial IVIG treatment was retrospectively verified in 175 KD subjects, consisting of 50 prospective and 125 retrospective patients in order to evaluate the efficacy of the re-treatment regimen.
  
  
  RESULTS
  Incidence of CAL in the study patients was lower than in the control patients, although differences were not significant both in the acute stage (within 1 month: 1/6, 16.7% vs 7/13, 53.8%; P= 0.177) and in the convalescent stage (after 1 month: 0/6, 0.0% vs 4/13, 30.8%; P= 0.255). According to the non-responder prediction system, the scores of six study and 13 control patients before initial IVIG treatment were similar (7.2 ± 1.9 vs 5.3 ± 3.1; P= 0.200). No serious adverse effects related to each treatment were noted in patients of either group.
  
  
  CONCLUSIONS
  Additional IVIG combined with concurrent PSL appears to be safe and worth evaluation for the treatment of acute KD unresponsive to initial IVIG treatment.
authors.affiliation: Department of Pediatrics, Chiba Kaihin Municipal Hospital, Chiba, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Jibiki
authors.affiliation: Department of Pediatrics, Chiba Kaihin Municipal Hospital, Chiba, Japan.
authors.forename: Izumi
authors.initials: I
authors.lastname: Kato
authors.affiliation: Department of Pediatrics, Chiba Kaihin Municipal Hospital, Chiba, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Shiohama
authors.affiliation: Department of Pediatrics, Chiba Kaihin Municipal Hospital, Chiba, Japan.
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Abe
authors.affiliation: Department of Pediatrics, Chiba Kaihin Municipal Hospital, Chiba, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Anzai
authors.affiliation: Department of Pediatrics, Chiba Kaihin Municipal Hospital, Chiba, Japan.
authors.forename: Nobue
authors.initials: N
authors.lastname: Takeda
authors.affiliation: Department of Pediatrics, Chiba Kaihin Municipal Hospital, Chiba, Japan.
authors.forename: Ken-Ichi
authors.initials: KI
authors.lastname: Yamaguchi
authors.affiliation: Department of Pediatrics, Chiba Kaihin Municipal Hospital, Chiba, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kanazawa
authors.affiliation: Department of Pediatrics, Chiba Kaihin Municipal Hospital, Chiba, Japan.
authors.forename: Tomomichi
authors.initials: T
authors.lastname: Kurosaki
mesh_terms: D000208:Acute Disease; D002675:Child, Preschool; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007155:Immunologic Factors / Q000008:administration & dosage*; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000175:diagnosis / Q000188:drug therapy*; D011239:Prednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D011239:Prednisolone; C021322:prednisolone hemisuccinate