Pediatric Cardiology

, Volume 34, Issue 4, pp 959–963 | Cite as

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

  • Masayuki TeraguchiEmail author
  • Hirotaro Ogino
  • Ken Yoshimura
  • Shoichiro Taniuchi
  • Minoru Kino
  • Hitoshi Okazaki
  • Kazunari Kaneko
Original Article


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.


Intravenous immunoglobulin therapy resistant Kawasaki disease Prospective study Steroid pulse therapy 



This study was partly supported by the Mami Mizutani Foundation.


  1. 1.
    Burns JC, Capparelli EV, Brown JA, Newburger JW, Glode MP (1998) Intravenous gamma-globulin treatment and retreatment in Kawasaki disease. US/Canadian Kawasaki Syndrome Study Group. Pediatr Infect Dis J 7:1144–1148Google Scholar
  2. 2.
    Furukawa T, Kishiro M, Akimoto K, Nagata S, Shimizu T, Yamashiro Y (2008) Effects of steroid pulse therapy on immunoglobulin-resistant Kawasaki disease. Arch Dis Child 93:142–146PubMedCrossRefGoogle Scholar
  3. 3.
    Furusho K, Kamiya T, Nakano H, Kiyosawa N, Shinomiya K, Hayashidera T, Tamura T, Hirose O, Manabe Y, Yokoyama T, Baba K, Mori C (1984) High-dose intravenous gammaglobulin for Kawasaki disease. Lancet 10:1055–1058CrossRefGoogle Scholar
  4. 4.
    Hashino K, Ishii M, Iemura M, Akagi T, Kato H (2001) Retreatment for immune globulin-resistant Kawasaki disease: a comparative study of additional immune globulin and steroid pulse therapy. Pediatr Int 43:211–217PubMedCrossRefGoogle Scholar
  5. 5.
    Inoue Y, Okada Y, Shinohara M, Kobayashi T, Kobayashi T, Tomomasa T, Takeuchi K, Morikawa A (2006) A multicenter prospective randomized trial of corticosteroids in primary therapy for Kawasaki disease: clinical course and coronary artery outcome. J Pediatr 149:336–341PubMedCrossRefGoogle Scholar
  6. 6.
    Kato H, Koike S, Yokoyama T (1979) Kawasaki disease: effect of treatment on coronary artery involvement. Pediatrics 63:175–179PubMedGoogle Scholar
  7. 7.
    Kawasaki T, Kosaki F, Okawa S, Shigematsu I, Yanagawa H (1974) A new infantile acute febrile mucocutaneous lymph node syndrome (MLNS) prevailing in Japan. Pediatrics 54:271–276PubMedGoogle Scholar
  8. 8.
    Miura M, Ohki H, Yoshiba S, Ueda H, Sugaya A, Satoh M, Yamagishi H (2005) Adverse effects of methylprednisolone pulse therapy in refractory Kawasaki disease. Arch Dis Child 90:1096–1097PubMedCrossRefGoogle Scholar
  9. 9.
    Miura M, Kohno K, Ohki H, Yoshiba S, Sugaya A, Satoh M (2008) Effects of methylprednisolone pulse on cytokine levels in Kawasaki disease patients unresponsive to intravenous immunoglobulin. Eur J Pediatr 167:1119–1123PubMedCrossRefGoogle Scholar
  10. 10.
    Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, Shulman ST, Bolger AF, Ferrieri P, Baltimore RS, Wilson WR, Baddour LM, Levison ME, Pallasch TJ, Falace DA, Taubert KA; Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease (2004) Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 110:2747–2471Google Scholar
  11. 11.
    Newburger JW, Sleeper LA, McCrindle BW, Minich LL, Gersony W, Vetter VL, Atz AM, Li JS, Takahashi M, Baker AL, Colan SD, Mitchell PD, Klein GL, Sundel RP (2007) Pediatric heart network investigators. Randomized trial of pulsed corticosteroid therapy for primary treatment of Kawasaki disease. N Engl J Med 356:663–675PubMedCrossRefGoogle Scholar
  12. 12.
    Ogata S, Bando Y, Kimura S, Ando H, Nakahata Y, Ogihara Y, Kaneko T, Minoura K, Kaida M, Yokota Y, Furukawa S, Ishii M (2009) The strategy of immune globulin resistant Kawasaki disease: a comparative study of additional immune globulin and steroid pulse therapy. J Cardiol 53:15–19PubMedCrossRefGoogle Scholar
  13. 13.
    Okada Y, Shinohara M, Kobayashi T, Inoue Y, Tomomasa T, Kobayashi T, Morikawa A (2003) Effect of corticosteroids in addition to intravenous gamma globulin therapy on serum cytokine levels in the acute phase of Kawasaki disease in children. J Pediatr 143:363–367PubMedCrossRefGoogle Scholar
  14. 14.
    Research Committee on Kawasaki Disease (1984) Report of subcommittee on standardization of diagnostic criteria and reporting of coronary artery lesions in Kawasaki disease. Ministry of Health and Welfare, TokyoGoogle Scholar
  15. 15.
    Terai M, Honda T, Yasukawa K, Higashi K, Hamada H, Kohno Y (2003) Prognostic impact of vascular leakage in acute Kawasaki disease. Circulation 108:325–330PubMedCrossRefGoogle Scholar
  16. 16.
    Wallace CA, French JW, Kahn SJ, Sherry DD (2000) Initial intravenous gamma globulin treatment failure in Kawasaki disease. Pediatrcs 105:e78CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Masayuki Teraguchi
    • 1
    • 2
    Email author
  • Hirotaro Ogino
    • 1
  • Ken Yoshimura
    • 1
  • Shoichiro Taniuchi
    • 1
  • Minoru Kino
    • 2
  • Hitoshi Okazaki
    • 3
  • Kazunari Kaneko
    • 1
  1. 1.Department of PediatricsKansai Medical UniversityOsakaJapan
  2. 2.Department of PediatricsNakano Children’s HospitalOsakaJapan
  3. 3.Department of PediatricsKawachi General HospitalOsakaJapan

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