Abstract
Treatment of the acute phase of Kawasaki disease (KD) remains controversial. Although aspirin plus intravenous gamma globulin (IVGG), the current treatment of choice, reduces coronary aneurysm formation to less than 5%, some children still develop aneurysms despite the use of high-dose IVGG. In our hospital, prednisolone (PSL) has been used for many years, and it was reported that it tended to reduce the duration of fever and the incidence of coronary arterial abnormalities. We concluded that steroids did not make coronary lesions worse. Our data suggest that PSL may have an additional benefit when used with IVGG. Since 1992, 97 cases (62 male and 35 female) of KD were treated with a predetermined protocol including PSL. Treatment with aspirin (30 mg/kg/day), dipyridamole (2 mg/kg/day), propranolol (1 mg/kg/day) and PSL (2 mg/kg/day) was started within 9 days of the onset of illness. PSL was administered over 3 weeks, during which the dose was reduced about every week. In severe cases (n=54) we added IVGG (200 mg/kg/day for 5 days). (Cases were severe if they met the following criteria: (1) younger than 13 months of age, (2) matched Harada's guideline, (3) development of a coronary abnormality was expected, or (4) persistent or relapsing fever at 48 hours after treatment with PSL.) Only one case (1.0%) had a moderate abnormality (maximal diameter was 4.2 mm in RCA). None of the patients had giant aneurysms. The duration of PSL administration was 25.7 ± 8.4 days (mean ± SD, maximal duration was 56 days). We consider that PSL should be used as early as possible and not be stopped early or suddenly. This protocol in which high-risk patients were treated with PSL and IVGG showed a satisfactory result.
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Shinohara, M., Kobayashi, T., Kobayashi, T. et al. Treatment of Acute Phase of Kawasaki Disease with Prednisolone. Pediatr Res 53, 181 (2003). https://doi.org/10.1203/00006450-200301000-00168
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DOI: https://doi.org/10.1203/00006450-200301000-00168
