title: A child with resistant Kawasaki disease successfully treated with anakinra: a case report.
abstract: Kawasaki disease (KD) is an acute self-limited systemic vasculitis of unknown etiology. Intravenous immunoglobulin (IVIG) is an effective treatment and decreases the risk of cardiac complications to less than 5%. In spite of its effectiveness, some children do not respond to this therapy and still develop coronary aneurysms (CAA). The optimal treatment for IVIG non-responsive patients remains controversial although corticoids have been suggested to be an effective treatment in some patients. For those patients still resistant to IVIG and corticoids, interleukin-1 receptor antagonists (IL-1RA) such anakinra could be an alternative.
  
  
  
  We present a 3 year-old Caucasian patient with KD without cardiac complications but with important resistance to treatment. After becoming resistant to IVIG and corticoids, anakinra proved to be an effective treatment.
  
  
  
  To our knowledge, this is the first report of the utility of IL-1RA in refractory KD without coronary impairment. The patient fulfilled the classical criteria for KD and, after becoming resistant to first and second line treatments, anakinra proved to be an effective treatment. Further studies are required to determine if this is an effective treatment option for other cases of resistant Kawasaki disease.
authors.affiliation: Pediatric Rheumatology Unit, Pediatrics Department, Hospital Parc Taulí Sabadell, Barcelona, Spain. jsanchez@tauli.cat.|Pediatric Rheumatology Unit, Pediatrics Department, Hospital Sant Joan de Déu Esplugues, Barcelona, Spain. jsanchez@tauli.cat.
authors.forename: J
authors.initials: J
authors.lastname: Sánchez-Manubens
authors.affiliation: Pediatrics Department, Hospital Parc Taulí Sabadell, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Gelman
authors.affiliation: Pediatrics Department, Hospital Parc Taulí Sabadell, Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Franch
authors.affiliation: Pediatric Cardiology Unit, Pediatrics Department, Hospital Parc Taulí Sabadell, Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Teodoro
authors.affiliation: Pediatric Cardiology Unit, Pediatrics Department, Hospital Parc Taulí Sabadell, Barcelona, Spain.
authors.forename: J R
authors.initials: JR
authors.lastname: Palacios
authors.affiliation: Pharmacy Department, Hospital Parc Taulí Sabadell, Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Rudi
authors.affiliation: Pediatrics Department, Hospital Parc Taulí Sabadell, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Rivera
authors.affiliation: Pediatric Rheumatology Unit, Pediatrics Department, Hospital Sant Joan de Déu Esplugues, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Antón
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein / Q000627:therapeutic use*; D009080:Mucocutaneous Lymph Node Syndrome / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D000893:Anti-Inflammatory Agents; D053590:Interleukin 1 Receptor Antagonist Protein
keywords: Anakinra; Case report; IL1 blockade; IVIG resistance; Kawasaki disease