Prednisolone May Work When IVIG Fails in Kawasaki

A 3-day course of prednisolone appears effective in Kawasaki disease patients who are unresponsive to multiple infusions of intravenous immunoglobulin, Dr. Seiichiro Takeshita reported.

Their success in treating nonresponders with prednisolone infusion suggests that IVIG-resistant patients may not require steroid pulse therapy, which has been associated with an increased risk of coronary aneurysm rupture, hypertension, seizures, and gastric erosion in this group (Clin. Pediatr. 2005;44:423–6).

Dr. Takeshita of the University of Shizuoka, Japan, and his colleagues administered 3-day courses of prednisolone every 8 hours (1–2 mg/kg per day) to six children, aged from 10 months to 9 years, who had failed to respond to repeated courses of IVIG for Kawasaki disease. Five of the children also received ulinastatin, a serine protease inhibitor not currently available in the United States.

Three patients had complications of the disease, including arthritis, myocarditis, and depressed left ventricular systolic function. All of the patients had dilated coronary arteries before prednisolone was administered. Five of the children became afebrile and had a significant decrease in C-reactive protein (CRP) levels within 24 hours of their first course of prednisolone.

The sixth patient had a persistent low-grade fever and high-CRP level after the first course, and developed a high-grade fever and high-CRP level 3 days after the first course ended. He then received a second, 3-day course of prednisolone (1.5 mg/kg per day). Within 24 hours, he became afebrile and had a significant drop in CRP level.