title: [The role of immunosuppressive agents in Kawasaki disease: a discussion of two cases].
abstract: BACKGROUND
  Kawasaki disease (KD) is the most common cause of acquired heart disease in developed countries. Ten percent of patients with KD develop coronary aneurism. Ten percent of patients treated with intravenous immunoglobulin (IgIV) have persistent coronary dilatations, which sustains the search for new therapies. We describe 2 cases of refractory KD and discuss the therapeutic options.
  
  
  METHODS
  A 3-year-old child and a 3-month-old infant had refractory KD. Both were treated with IgIV and corticosteroids. They both had persistent fever and major coronary artery dilatation. The first patient received a treatment with acetyl-salicylic-acid (ACA) only. The second received an immuno-therapy with an anti-TNF-α agent. Fever and inflammatory symptoms disappeared within 12h in the second case. Coronary artery aneurisms worsened during the first month and then stabilized. The first child had fever and inflammatory symptoms for a longer duration, but coronary artery dilatations stabilized and disappeared with no additional treatment than ACA.
  
  
  CONCLUSIONS
  TNF-α is known to be one of the inflammatory factors involved in KD disease. Anti-TNF-α agents have been tested in treatment of refractory KD. In one of the cases reported herein, this therapy was not effective on coronary artery aneurism. More studies are needed to define the optimal treatment of refractory KD.
authors.affiliation: Service de pédiatrie générale, hôpital de la Mère et de l'Enfant, 8, avenue Dominique-Larrey, 87000 Limoges, France. Marianne.peyre@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Peyre
authors.forename: C
authors.initials: C
authors.lastname: Laroche
authors.forename: C
authors.initials: C
authors.lastname: Etchecopar
authors.forename: P
authors.initials: P
authors.lastname: Brosset
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000188:drug therapy; D001241:Aspirin / Q000627:therapeutic use; D002675:Child, Preschool; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging / Q000188:drug therapy; D004351:Drug Resistance; D000068800:Etanercept; D005334:Fever / Q000188:drug therapy / Q000209:etiology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000188:drug therapy*; D011859:Radiography; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014463:Ultrasonography
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D007074:Immunoglobulin G; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000068800:Etanercept; D001241:Aspirin