title: Late development of coronary artery abnormalities could be associated with persistence of non-fever symptoms in Kawasaki disease.
abstract: BACKGROUND
  Persistent fever after intravenous immunoglobulin (IVIG) is considered to be a major criterion of IVIG resistance in Kawasaki disease (KD), and a risk factor for the development of coronary artery abnormalities (CAA). However, the importance of persistent non-fever symptoms after defervescence has not yet been investigated. We examined the relationship between persistent non-fever symptoms and CAA in KD.
  
  
  METHODS
  We conducted a retrospective cohort study of patients hospitalized with KD at the National Center for Child Health and Development between 1 April 2008 and 31 March 2009. Patients were divided into two groups; group A included patients who still had non-fever symptoms one month after onset of the illness and group B included patients who did not have persistent non-fever symptoms. Demographic, clinical variables were compared between the groups.
  
  
  RESULTS
  Seventy-seven KD patients treated with IVIG were retrospectively analyzed. Patients were divided into two groups; group A included 12 (15.6%) patients and group B 65 (84.4%) patients. Demographic data, baseline laboratory data, and fever duration did not differ between the groups. In group A patients the most common persistent non-fever symptoms were lip erythema (n = 6) and bulbar conjunctivitis (n = 8). One month after onset of the illness CAA developed in seven of 77 patients (9.1%), four (33%) in group A and three (4.6%) in group B (odds ratio 10.3; 95% CI 1.9-54.8). Three patients in group A and one patient in group B developed CAA after the resolution of fever.
  
  
  CONCLUSIONS
  Persistence of non-fever symptoms after IVIG may suggest persistence of latent inflammation, which may increase the risk of CAA. Therefore, patients with persistent non-fever symptoms may be at risk of developing CAA, even after defervescence. A prospective trial of additional IVIG for such patients should be considered.
authors.affiliation: Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan. fukuda-s@ncchd.go.jp.
authors.forename: Sayaka
authors.initials: S
authors.lastname: Fukuda
authors.forename: Shuichi
authors.initials: S
authors.lastname: Ito
authors.forename: Shinji
authors.initials: S
authors.lastname: Oana
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Sakai
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kato
authors.forename: Jun
authors.initials: J
authors.lastname: Abe
authors.forename: Ryuko
authors.initials: R
authors.lastname: Ito
authors.forename: Akihiko
authors.initials: A
authors.lastname: Saitoh
authors.forename: John Ichiro
authors.initials: JI
authors.lastname: Takayama
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