Original Paper

European Journal of Pediatrics

, Volume 168, Issue 2, pp 181-185

First online:

Pulse methylprednisolone with gammaglobulin as an initial treatment for acute Kawasaki disease

  • Keiko OkadaAffiliated withDepartment of Pediatric Hematology/Oncology, Osaka City General Hospital Email author 
  • , Junichi HaraAffiliated withDepartment of Pediatric Hematology/Oncology, Osaka City General Hospital
  • , Ichiro MakiAffiliated withIkeda Municipal Hospital
  • , Kazunori MikiAffiliated withItami Municipal Hospital
  • , Kouji MatsuzakiAffiliated withSuita Municipal Hospital
  • , Taro MatsuokaAffiliated withToyonaka Municipal Hospital
  • , Takehisa YamamotoAffiliated withMino City Hospital
  • , Toshinori NishigakiAffiliated withOsaka Keisatsu Hospital
  • , Syunji KurotobiAffiliated withOsaka University Graduate School of Medicine
    • , Tetsuya SanoAffiliated withOsaka Kosei-nenkin Hospital
    • , For the Osaka Kawasaki Disease Study Group

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Approximately 15–20% of patients with Kawasaki disease (KD) are not responsive to high-dose intravenous gammaglobulin (IVIG). We have previously reported a predictive method for identifying IVIG-non-responsive patients (high-risk KD patients). We determined the safety and effectiveness of pulse methylprednisolone with high-dose IVIG (mPSL+IVIG) as a primary treatment for high-risk KD patients. Sixty-two high-risk KD patients were treated with pulse methylprednisolone 30 mg/kg over 2 h, followed by IVIG 2 g/kg over 24 h (mPSL+IVIG group) and were compared with a historical control group of 32 high-risk patients treated with IVIG 2 g/kg alone at the participating hospitals before this study was opened (IVIG group). High-risk patients were identified with at least two of three predictors (C-reactive protein ≥7 mg/dL, total bilirubin ≥0.9 mg/dL or aspartate aminotransferase ≥200 IU/L). Sixty-six percent (95% confidence interval [CI] 54–78%) of patients had a prompt defervescence in the mPSL+IVIG group compared with 44% (95% CI 26–62%) for the IVIG group (p = 0.048). Coronary artery lesions were observed in 24.2% (95% CI 13.2–35.2%) and 46.9% (95% CI 28.6–65.2%) of patients in the mPSL+IVIG and IVIG groups, respectively (p = 0.025). This is the first report showing that mPSL+IVIG is effective and safe as a primary treatment for high-risk KD patients.


Kawasaki disease Methylprednisolone Coronary disease