• Allergy and Immunology
• Emergency Service, Hospital
• Health Care Economics and Organizations
• Paediatrics
• Rheumatology

Kawasaki disease (KD), a medium vessel vasculitis of unknown aetiology, remains the leading cause of acquired heart disease in children of developed nations and is being increasingly recognised in low-income and middle-income countries. Although introduction of intravenous immunoglobulin (IVIG) has been unequivocally proven to significantly reduce the risk of KD-associated coronary artery aneurysms (CAAs), the literature suggests that as high as 19% of children will still develop cardiac sequelae even with timely administration.1 Established risk factors for development of CAAs include coronary artery dilatation at baseline echocardiogram, young age (<12 months), male sex, persistence or recrudescence of fever 36 hours post IVIG administration and Asian race.2 Given the acute and long-term morbidity that can be associated with coronary artery involvement, several adjunctive agents to IVIG have been studied for primary intensification or subsequent treatment. Despite extensive research, heterogeneity of study subjects, drug dosing, outcome measures and follow-up limits the strength of evidence to date, although additional anti-inflammatory treatment at presentation for those with established CAAs appears to improve outcomes.

Infliximab, a tumour necrosis factor-alpha (TNF-α) monoclonal antibody, is one agent that has been studied both as adjunctive first-line or subsequent treatment, with introduction of the agent as standard practice in local protocols for a decade. Tremoulet et al,3 conducted a randomised controlled trial of 5 mg/kg of …