title: Steroid pulse therapy for Kawasaki disease unresponsive to additional immunoglobulin therapy.
abstract: BACKGROUND
  The optimal management of Kawasaki disease (KD) unresponsive to intravenous immunoglobulin (IVIG) therapy remains unclear.
  
  
  OBJECTIVE
  To prospectively evaluate the efficacy and safety of intravenous methylprednisolone pulse (IVMP) therapy in KD cases unresponsive to additional IVIG.
  
  
  METHODS
  KD patients who initially received IVIG (2 g/kg/24 h) and acetylsalicylic acid within nine days after disease onset were studied. Patients who did not respond received additional IVIG (2 g/kg/24 h), and those who still did not respond were given IVMP (30 mg/kg/day) for three days, followed by oral prednisolone. The response to treatment, echocardiographic findings and adverse effects were evaluated.
  
  
  RESULTS
  Among 412 KD cases, 74 (18.0%) were treated with additional IVIG; 21 (28.4%) of the latter cases subsequently received IVMP followed by prednisolone. All cases became afebrile soon after IVMP infusion and did not have a high-grade fever during treatment with prednisolone for two to six weeks. Four weeks after disease onset, coronary artery lesions (CAL) were diagnosed according to the Japanese Ministry of Health and Welfare or the American Heart Association criteria in two of the 21 cases treated with IVMP plus prednisolone; among all 412 cases, three (0.7%) and eight (1.9%) had CAL according to each criteria, respectively. All CAL regressed completely one year after disease onset. Adverse effects of IVMP, such as hypothermia and sinus bradycardia, resolved spontaneously.
  
  
  CONCLUSIONS
  In KD patients unresponsive to additional IVIG, IVMP promptly induced defervescence, and subsequent oral prednisolone suppressed recurrence of fever. IVMP followed by prednisolone therapy may prevent CAL, without severe adverse effects.
authors.affiliation: Division of Cardiology, Tokyo Metropolitan Children's Medical Center (formerly Tokyo Metropolitan Kiyose Children's Hospital), Fuchu, Tokyo, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Miura
authors.forename: Takuya
authors.initials: T
authors.lastname: Tamame
authors.forename: Takashi
authors.initials: T
authors.lastname: Naganuma
authors.forename: Shino
authors.initials: S
authors.lastname: Chinen
authors.forename: Megumi
authors.initials: M
authors.lastname: Matsuoka
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Ohki