Late Intravenous Immunoglobulin in Kawaski Disease Patients: Is It Worth Doing?

Nowadays we tend to keep Kawasaki Disease (KD) high up in the differential of a child who presents with rash and fever. If we don’t think about it until a week or two after the symptoms have initially presented, can treatment with intravenous immunoglobulin (IVIG) still make a difference in reducing inflammation and preventing coronary artery lesions? Muta et al. (doi: 10.1542/peds.2011-1704) share with us the results of a survey in Japan that compared pair-matched controls of the same age and sex treated with IVIG 4 to 8 days versus 11 to 20 days after presentation of symptoms and signs. While there is some benefit to IVIG in terms of resolving ongoing inflammation, late treatment is not the panacea for prevention of coronary artery lesions. If you don’t think about KD early on in its onset, you might not be thinking rash-ionally in your differential diagnosis when characteristic symptoms and signs present — especially if you want to reduce the risk of coronary arterial aneurysms. Read this article to learn more about the benefits but also the risks of delayed IVIG treatment.