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ORIGINAL ARTICLE
Korean J Pediatr 2016 July;59(8) :328-334.
Published online 2016 August 15.       
Clinical outcome of patients with refractory Kawasaki disease based on treatment modalities
Hyun Jung Kim1, Hyo Eun Lee1, Jae Won Yu2, Hong Ryang Kil2
1Department of Pediatrics, Eulji Universitiy School of Medicine, Daejeon, Korea
2Department of Pediatrics, Chungnam University School of Medicine, Daejeon, Korea
Corresponding Author: Hong Ryang Kil ,Tel: +82-42-280-7251, Fax: +82-42-255-3158, Email: gilhong@cnu.ac.kr
Copyright © 2016 by The Korean Pediatric Society
ABSTRACT
Purpose: Although a significant number of reports on new therapeutic options for refractory Kawasaki disease (KD) such as steroid, infliximab, or repeated intravenous immunoglobulin (IVIG) are available, their effectiveness in reducing the prevalence of coronary artery lesions (CAL) remains controversial. This study aimed to define the clinical characteristics of patients with refractory KD and to assess the effects of adjuvant therapy on patient outcomes.
Methods: We performed a retrospective study of 38 refractory KD patients from January 2012 to March 2015. We divided these patients into 2 groups: group 1 received more than 3 IVIG administration+ steroid therapy, (n=7, 18.4%), and group 2 patients were unresponsive to initial IVIG and required steroid therapy or second IVIG (n=31, 81.6%). We compared the clinical manifestations, laboratory results, and echocardiographic findings between the groups and examined the clinical utility of additional therapies in both groups.
Results: A significant difference was found in the total duration of fever between the groups (13.0 4.04 days in group 1 vs. 8.872.30 days in group 2; P=0.035). At the end of the follow-up, all cases in group 1 showed suppressed CAL. In group 2, coronary artery aneurysm occurred in 2 patients (6.4 %). All the patients treated with intravenous corticosteroids without additional IVIG developed CALs including coronary artery aneurysms.
Conclusion: No statistical difference was found in the development of CAL between the groups. Prospective, randomized, clinical studies are needed to elucidate the effects of adjunctive therapy in refractory KD patients.
Keywords: Mucocutaneous lymph node syndrome | Adjuvant therapy | Coronary disease
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