Use of Corticosteroid in Children with Unresponsiveness to Intravenous Immunoglobulin in Kawasaki Disease

Authors

1 Infection Control and Hand Hygiene Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Specialist of pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Pediatric Rheumatologist, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Assistant of Nuclear Medicine, Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Background
Kawasaki Disease (KD) is a vasculitis with multi-organ involvementof unknown etiology; it is the most common cause of pediatric-heart diseases in developed countries. Treatment with Intravenous Immunoglobulin (IVIG) prevents coronary artery lesions; although there are some IVIG-resistant cases, combination therapy with corticosteroids and IVIG is one of the recommendations for treatment of these cases. The aim of this study was to compare these three options for treatment of Kawasaki Disease and to evaluate their ability to deal with coronary artery complication of Kawasaki Disease.
Materials and Methods
A prospective cross- sectional study of hospitalized cases of Kawasaki Disease, conducted in pediatric department of Imam Reza hospital, Mashhad-Iran, during 2013 to 2015 (18 months). Based on demographic and clinical data of these patients, children with high risk of unresponsiveness to IVIG therapy (based on Harada score), were determined and treated with IVIG and corticosteroids- combination initially. Follow-up patients for heart complications were 6 weeks.
Results
Twenty five patients (89.2%) out of total 28 hospitalized patients in this period of time who fulfilled diagnostic criteria were considered as complete Kawasaki Disease. Coronary Artery Lesions (CALs) were shown in 4 patients during the follow-up period, with high risk in patients with incomplete presentation (33.3% versus 12%, P<0.05). None of the children were treated with IVIG and corticosteroids combination therapy at the onset showed coronary artery lesions.
Conclusion
The current study showed that IVIG plus intravenous methylprednisolone (IVMP) combination therapy is a safe and effective treatment regimen in prevention of CALs.

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