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Steroid Pulse Therapy for Children With Intravenous Immunoglobulin Therapy–Resistant Kawasaki Disease: A Prospective Study

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Abstract

Patients with Kawasaki disease (KD) who did not respond to the initial IVIG are known to have higher risk for developing coronary arterial lesions (CALs). Our aim is to clarify whether patients with initial IVIG resistant KD may benefit from methylprednisolone pulse therapy (MPT) in comparison with re- treatment of IVIG (2nd IVIG). A total of 237 patients (median age: 2 years 2 months; range 1 months–10 years) with KD were initially treated with IVIG (2 g/kg). Among them, 41 patients (22 %) were assessed as IVIG resistance: these patients were allocated to either group A receiving MPT (n = 14) or group B receiving the 2nd IVIG (n = 27). Patients with resistant to the additional therapy (MPT or 2nd IVIG) were received second IVIG (group A) or MPT (group B). Changes in leukocyte count, C-reactive protein and albumin before and after an additional therapy were significantly greater in group A than those in group B. However, the prevalence of CALs did not differ between the groups (36 % in group A and 26 % in group B, p > 0.05). There was no significant difference in the medical cost between the groups (median cost: 92,032 JPY in group A and 97,331 JPY in group B). MPT does not reduce the risk of development to CAL and does not seem to be beneficial as single agent therapy for IVIG resistant KD.

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Acknowledgments

This study was partly supported by the Mami Mizutani Foundation.

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Authors and Affiliations

  1. Department of Pediatrics, Kansai Medical University, 2-3-1 Shin-machi, Hirakatashi, Osaka, 573-1191, Japan

    Masayuki Teraguchi, Hirotaro Ogino, Ken Yoshimura, Shoichiro Taniuchi & Kazunari Kaneko

  2. Department of Pediatrics, Nakano Children’s Hospital, 4-13-17 Asahiku Shinmori, Osaka, 535-0022, Japan

    Masayuki Teraguchi & Minoru Kino

  3. Department of Pediatrics, Kawachi General Hospital, 1-31 Yokomakura, Higashiosakashi, Osaka, 578-0954, Japan

    Hitoshi Okazaki

Authors
  1. Masayuki Teraguchi
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  2. Hirotaro Ogino
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  3. Ken Yoshimura
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  4. Shoichiro Taniuchi
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  5. Minoru Kino
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  6. Hitoshi Okazaki
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  7. Kazunari Kaneko
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Correspondence to Masayuki Teraguchi.

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Teraguchi, M., Ogino, H., Yoshimura, K. et al. Steroid Pulse Therapy for Children With Intravenous Immunoglobulin Therapy–Resistant Kawasaki Disease: A Prospective Study. Pediatr Cardiol 34, 959–963 (2013). https://doi.org/10.1007/s00246-012-0589-9

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  • DOI: https://doi.org/10.1007/s00246-012-0589-9

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