Clinical and Laboratory ObservationsTreatment of severe complicated Kawasaki disease with oral prednisolone and aspirin☆
Section snippets
PATIENTS
All patients fulfilled the diagnostic criteria for KD and had supportive elevated inflammatory markers. There was no clinical or laboratory evidence of any other disease known to mimic KD. All received IVIG, 2 g/kg (over 12 hours), at diagnosis except a Jehovah's Witness patient for whom IVIG was unacceptable. In addition, all patients received aspirin, 30 mg/kg/d, during the acute phase and 5 mg/kg/d in the convalescent phase. Second-line treatment depended on the degree of progressive
Discussion
The treatment of KD has been subject to trials over the last 20 years. Initially, aspirin was the mainstay of treatment, as an anti-inflammatory agent. A recent meta-analysis showed no significant difference in the incidence of coronary aneurysms in a comparison of a moderate anti-inflammatory dose (<80 mg/kg/d) with high-dose aspirin (>80 mg/kg/d).3 It is currently our practice to prescribe aspirin, 30 mg/kg/d.
Steroid treatment in KD has been controversial4; 92 patients were divided into 5
References (12)
- et al.
Treatment of Kawasaki disease with corticosteroid [letter]
J Pediatr
(1996) - et al.
Treatment of immune globulin resistant Kawasaki disease with pulsed doses of corticosteroids
J Pediatr
(1996) - et al.
Treatment of Kawasaki disease with corticosteroid [letter]
J Pediatr
(1996) - et al.
Gamma globulin re-treatment in Kawasaki disease
J Pediatr
(1993) - et al.
Kawasaki disease: clinical perspective
J Pediatr
(1987) Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children [in Japanese]
Jpn J Allergy
(1967)
Cited by (76)
Kawasaki Disease
2013, Vascular Medicine: A Companion to Braunwald's Heart Disease: Second Edition1α,25-Dihydroxyvitamin D<inf>3</inf> inhibits vascular cellular adhesion molecule-1 expression and interleukin-8 production in human coronary arterial endothelial cells
2012, Journal of Steroid Biochemistry and Molecular BiologyCitation Excerpt :However, at least 10% of KD patients fail to exhibit defervescence with IVIG therapy [19,20]. Some reports have recommended alternative anti-inflammatory therapies with steroids, and recently, with ulinastatin and infliximab, for the treatment of KD [42–46]. In this study 1α,25-(OH)2D3 exhibits anti-inflammatory effects after TNF-α stimulation (from 4 h onwards).
Corticosteroid administration for patients with coronary artery aneurysms after Kawasaki disease may be associated with impaired regression
2012, International Journal of CardiologyCitation Excerpt :Results were comparable whether CAA sizes were modelled as BSA-adjusted z-scores or absolute diameter. The use of corticosteroids as treatment for patients who fail to respond to initial IVIG therapy is commonplace [22], several small case studies reported that the administration of corticosteroids to KD patients with persistent or recurrent fever despite initial IVIG treatment, showed defervescence [9–11]. Similar results were seen in a randomized trial demonstrating that the treatment of IVIG-resistant patients with pulse corticosteroids was correlated with shorter fever and lower medical costs but no difference in the prevalence of coronary artery abnormalities when compared to those who received a second course of IVIG [12].
Rheumatic Diseases of Childhood: Therapeutic Principles
2010, Pediatric Allergy: Principles and Practice Expert Consult: Second EditionKawasaki disease
2010, Paediatric Cardiology
- ☆
Reprint requests: Michael J. Dillon, MBBS, FRCP, Department of Paediatric Nephrology, Great Ormond Street Hospital, London, WC1N 3JH, UK.