RT Journal Article
SR Electronic
T1 Corticosteroid treatment of refractory Kawasaki disease.
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 803
OP 809
VO 33
IS 4
A1 Bianca A Lang
A1 Rae S M Yeung
A1 Kiem G Oen
A1 Peter N Malleson
A1 Adam M Huber
A1 Mark Riley
A1 Regan Ebbeson
A1 Suzanne E Ramsey
A1 Ronald M Laxer
A1 Earl D Silverman
A1 Brian W McCrindle
A1 Savithiri Ratnapalan
A1 Brian M Feldman
YR 2006
UL http://www.jrheum.org/content/33/4/803.abstract
AB OBJECTIVE: To review the indications for corticosteroids in patients with Kawasaki disease (KD) treated by pediatric rheumatologists in Canada and to determine their efficacy on fever in patients with refractory KD. METHODS: All practicing pediatric rheumatologists in Canada identified KD patients treated with corticosteroids and completed a standard data form that included demographics, clinical and laboratory features, imaging studies, and therapeutic interventions, by chart review. RESULTS: Thirty-two patients with KD (14 female; 18 male: mean age 4.6 years) were treated with corticosteroids. Corticosteroids were used in 26 patients (81%) for persistent fever despite treatment with intravenous immunoglobulin (IVIG) (refractory KD), 5 patients (19%) for congestive heart failure, and 1 patient for persistent acute phase symptoms other than fever. The 26 patients with refractory KD are the primary subject of this report. Twenty-two patients (85%) had rapid, sustained resolution of fever after corticosteroids. There were no serious reported adverse effects. Eight patients (31%) treated with corticosteroids developed coronary artery (CA) aneurysms and 9 (35%) developed CA dilatations without aneurysms. Of those who developed CA aneurysm, 4 had aneurysms detected prior to IV methylprednisolone (MP) on echocardiograms performed on days 6-27 (mean day 13) of illness. The remaining 4 patients had CA aneurysm detected after IVMP therapy, on echocardiograms performed on days 13-49 (mean day 23) of illness, 1-25 days (mean 9 days) after IVMP. In patients with one year or more of followup, 46% had resolution of CA abnormalities. CONCLUSION: Corticosteroids are effective in the treatment of fever in most patients with IVIG-refractory KD. A multicenter prospective study is needed to determine the effect of corticosteroids on CA outcome in patients with refractory KD.