Effects of steroid pulse therapy on immunoglobulin-resistant Kawasaki disease

Abstract

The findings suggest that IVMP is an effective additional treatment 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.

Gram-negative Septicemia after Infliximab Treatment in an Infant with Refractory Kawasaki Disease

“…Unresponsiveness to IVIG has been considered a major risk factor for the development of coronary artery lesions 3) . Recently, it has been suggested that pulse methylprednisolone 5) and second line treatments, such as infliximab and methotrexate 10) , may be used for children with KD who fail to respond to a repeated doses of IVIG.…”

“…Nevertheless, approximately 10% of patients are refractory to IVIG treatment; refractory KD is defined as persistent fever of ≥38.5℃ for 36 hours after initial IVIG treatment 3) . These patients are in need of additional therapy, such as repeated doses of IVIG or pulse methylprednisolone 4,5) .…”

Clinical Manifestation, Diagnostics and Treatment of Kawasaki Disease: Known Data and Unsolved Questions

“…ретроспективного исследо-вания, показавшего, что диаметр аневризм КА через 2-3 мес и через 1 год после манифестации СК у паци-ентов, не получавших глюкокортикоиды, уменьшался, а у получавших эти препараты -увеличивался неза-висимо от продолжительности лечения [52]. Кроме того, известно, что применение глюкокортикоидов повышает риск тромбообразования, поэтому есть рекомендации о назначении этих препаратов больным СК одновре-менно с гепарином [55].…”

Cardiovascular Lesions of Kawasaki Disease: From Genetic Study to Clinical Management

“…IVMP (30 mg/kg MP per day for 3 days) or a second dose of IVIG (2 g/kg) was prescribed to KD patients with fever and marked inflammation (i.e., non-exudative conjunctival injection, strawberry tongue, fissured lips, and erythematous change at the BCG inoculation site) 48 hours after initial IVIG treatment. (22,(82)(83)(84) The safety of IVMP therapy in patients with KD is uncertain. Miura et al (85) reported that IVMP (N = 11) incurred a higher incidence of sinus bradycardia and hyperglycemia when compared with the additional IVIG group (N = 11).…”