Pulse methylprednisolone therapy in the treatment of immune globulin-resistant Kawasaki disease: case report and review of the literature

Hung, Jeng-Juh; Chiu, Cheng-Hsun

doi:10.1179/027249304225013330

Cited by 16 publications

(12 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…3,[10][11][12][13][14] All patients who failed initial IVIG therapy received additional IVIG 2 g/kg therapy without aspirin, and 66.67% of these had defervescence within 3 days after the additional IVIG, similar to results of other studies with approximately two thirds of initial nonresponders responding to a second dose of IVIG plus aspirin. 12,15,16 The result of our study indicates that the use of aspirin in acute KD has no significant effect on preventing the failure of IVIG therapy. In addition, when patients are not responsive to initial IVIG therapy, early re-treatment with other anti-inflammatory measures (additional IVIG or corticosteroid therapy), rather than high-dose aspirin, should be considered.…”

Section: Discussionmentioning

confidence: 64%

Treatment of Acute Kawasaki Disease: Aspirin’s Role in the Febrile Stage Revisited

et al. 2004

View full text Add to dashboard Cite

ABSTRACT. Objective. To evaluate the effect of treatment without aspirin in the acute phase of Kawasaki disease (KD) and to determine whether it is necessary to expose children to high-or medium-dose aspirin.Methods. A total of 162 patients who fulfilled the established criteria of acute KD between 1993 and 2003 were included in this retrospective study. All patients were treated with high-dose intravenous immunoglobulin (IVIG; 2 g/kg) as a single infusion without concomitant aspirin treatment. Low-dose aspirin (3-5 mg/kg per day) was subsequently prescribed when fever subsided. Patients who had defervescence within 3 days after the completion of IVIG treatment were classified as the IVIG-responsive group, and those whose fever persisted for >3 days were classified as the IVIG-nonresponsive group. The 162 patients were divided further into 2 groups: those who were treated with IVIG before illness day 5, and those who were treated after illness day 5. We compared the response rate of IVIG therapy, duration of fever, and incidence of coronary artery abnormalities (CAAs) between these groups.Results. A total of 153 patients were classified into the IVIG-responsive group, and 128 (83.66%) of them had defervescence within 24 hours after completion of IVIG therapy. Nine (5.56%) patients were classified into the IVIG nonresponsive group, and all received additional IVIG (2 g/kg) without aspirin. Six (66.67%) had defervescence within 3 days after additional therapy. Patients in the IVIG-nonresponsive group had a significantly higher incidence of CAAs than those in the IVIG-responsive group (25% vs 2.92%). In the group that was treated before illness day 5 (n ‫؍‬ 16), all patients had defervescence within 3 days after IVIG therapy and 13 (81.25%) had defervescence within 24 hours. In the group that was treated after illness day 5 (n ‫؍‬ 146), 137 (93.84%) patients had defervescence within 3 days and 115 (78.77%) had defervescence within 24 hours. One (6.67%) patient in the group that was treated before illness day 5 got a new onset of CAAs, as did 5 (3.85%) in the group that was treated after illness day 5. There was no statistically significant difference in the response rate of IVIG therapy, duration of fever, and incidence of CAAs between these 2 groups. Conclusion.The results of our study indicate that the treatment without aspirin in acute stage of KD had no effect on the response rate of IVIG therapy, duration of fever, or incidence of CAAs when children were treated with high-dose (2 g/kg) IVIG as a single infusion, despite treatment before or after day 5 of illness. We conclude that it seems unnecessary to expose children to high-or medium-dose aspirin therapy in acute KD when the available data show no appreciable benefit in preventing the failure of IVIG therapy, formation of CAAs, or shortening the duration of fever. K awasaki disease (KD) is an acute systemic vasculitis of unknown origin that occurs predominantly in children who are Ͻ5 years old. The most significant complication is coronary arteritis, and an...

show abstract

Section: Discussionmentioning

confidence: 64%

Treatment of Acute Kawasaki Disease: Aspirin’s Role in the Febrile Stage Revisited

et al. 2004

View full text Add to dashboard Cite

show abstract

“…All the patients were treated successfully with pulse methylprednisolone with no adverse effects noted. A recent review article suggests that pulse methylprednisolone therapy should be considered if there is no response to two standard doses of IVIG treatment [15]. …”

Section: Discussionmentioning

confidence: 99%

Incomplete, atypical kawasaki disease or evolving systemic juvenile idiopathic arthritis: a case report

Shaikh

Ishaque

Saleem

2009

Cases J

View full text Add to dashboard Cite

Kawasaki disease is an acute febrile condition seen in children. However, it is also well recognized that some patients do not fulfill the classic diagnostic criteria for the diagnosis of kawasaki disease. The incomplete form of kawasaki disease is termed as ‘Incomplete KD’ or ‘Atypical KD’. We present a case of a 6 year old child with a history of prolonged fever, periorbital, oral and lip changes, changes in the extremities and an erythamatous, maculopapular rash. Based on the physical exam and her echocardiogram that showed right coronary artery dilatation, Intravenous immune globulin was administered in this patient. This patient was refractory to two doses of intravenous immune globulin and therefore was started on methylprednisolone, to which she responded dramatically. The diagnostic dilemma primarily arose when this child presented with joint pain a day after her discharge from the hospital and a positive laboratory workup. So, was this a case of incomplete Kawasaki refractory to intravenous immuno globulin therapy or systemic juvenile idiopathic arthritis? We suggest that physicians should be cognizant of the fact that they must individualize every patient’s management to the best of their knowledge and judgment, rather than merely going by the guidelines.

show abstract

“…In refractory Kawasaki disease, however, corticosteroids as 'rescue therapy', either oral or pulsed (methylprednisolone 30 mg/kg, one to three courses), may be an alternative and safe treatment [35][36][37].…”

Section: Coronary Artery Lesionsmentioning

confidence: 99%

Kawasaki disease

Falcini

2006

Current Opinion in Rheumatology

View full text Add to dashboard Cite

Due to earlier recognition, aggressive medical treatment, and surgical procedures, the quality of life in patients with Kawasaki disease is significantly improved. The identification of children at high risk for coronary artery aneurysms is crucial in order to reduce the occurrence of sudden death in adolescence and early adulthood. High parameters of inflammation, anemia, and low sodium and albumin levels, along with persistent unexplained fever, should alert clinicians to suspect the disease even though all clinical symptoms are lacking.

show abstract

Pulse methylprednisolone therapy in the treatment of immune globulin-resistant Kawasaki disease: case report and review of the literature

Cited by 16 publications

References 16 publications

Treatment of Acute Kawasaki Disease: Aspirin’s Role in the Febrile Stage Revisited

Treatment of Acute Kawasaki Disease: Aspirin’s Role in the Febrile Stage Revisited

Incomplete, atypical kawasaki disease or evolving systemic juvenile idiopathic arthritis: a case report

Kawasaki disease

Contact Info

Product

Resources

About