Aim: The use of intravenous immunoglobulin (IVIG) is well-established as an initial therapy for Kawasaki disease (KD), but treatment for IVIG-resistant KD cases remains uncertain. We analyzed the effects of intravenous methylprednisolone pulse therapy (IVMP) compared with additional IVIG therapy in IVIG-resistant patients.
Methods: We have administered IVMP as an additional therapy to KD patients with persistent or recurrent fever after a single dose of IVIG at Juntendo University Hospital and affiliated medical institutions between May 2003 and March 2006. We have retrospectively analyzed and compared by chart review the effectiveness of the treatment and the incidence of coronary lesions between patients who received IVMP and those who received additional IVIG.
Results: A total of 411 patients with KD were treated with a single dose of IVIG. Of the 63 IVIG-resistant patients, 44 patients were administered IVMP and 19 patients who were administered additional IVIG. A total of 34 cases (77.3%) that received IVMP and 12 cases (63.2%) that received additional IVIG were successfully treated. Five of the 10 cases that did not respond to IVMP and two of the seven non-responders to additional IVIG developed coronary artery aneurysms (CAA). Although fever initially resolved faster in the IVMP-resistant group, there was a delay in fever recurrence, which ultimately delayed the final resolution of fever.
Conclusions: Our findings suggest that IVMP is an effective additional therapy for IVIG-resistant KD. However, there was a tendency for fever to recur later in IVMP-resistant patients, which could potentially delay the therapeutic decision-making process.
- Kawasaki disease
- coronary artery aneurysms
- methylprednisolone pulse therapy