Abstract 121: Outcome Of Patients With Kawasaki Disease Treated With Intravenous Pulse Methylprednisolone As Primary Therapy: An 8 Year Single Center Experience
Kawasaki disease (KD) is a medium vessel vasculitis with predilection to affect the coronary arteries. While intravenous immunoglobulin (IVIG) remains the standard primary treatment, the cost remains a big burden for parents of patients in developing countries. Steroids do have a role in IVIG-resistant KD but studies on its benefit in addition to IVIG as primary treatment are conflicting. In our institution, parents who cannot afford IVIG consented to intravenous pulse methylprednisolone (IV MP) as an alternative primary treatment.
Objective: To review the outcome of KD patients treated with IV MP as primary treatment.
Methods: Retrospective chart review of patients who fulfilled the diagnostic criteria for KD and treated with IV MP (30 mg/kg/dose, maximum of 1 gm/dose, given once daily for 3 consecutive days) plus high dose Aspirin from January 2006 to December 2013.
Results: A total of 36 patients were included in the study with a mean age of 4.2 years (range 0.4-12.6). The F:M ratio was 1:1. Majority (75% - 27/36) of the patients received the treatment before the tenth day of illness. There was clinical improvement in all patients with lysis of fever and resolution of all signs and symptoms immediately after the first dose of IV MP. None of the patients had a relapse of KD. The CRP significantly decreased after the treatment in all patients. For all patients, baseline echocardiography was done by a single pediatric cardiologist and was repeated after 2 months, 6 months, then yearly. At baseline, 36 patients had pericardial effusion, 13 with perivascular brightness, 15 with coronary ectasia and 8 with valvular abnormalities (MR, AR, TR). Follow up evaluation after 2 months showed no echocardiographic abnormalities in all patients, up until the yearly echo. None of the patients developed coronary aneursysm. There was no reported immediate nor long term side effects from the steroid therapy.
Conclusion: Intravenous methylprednisolone is effective in controlling the clinical manifestations of KD and in preventing cardiac complications. It is safe and well-tolerated by patients. It can be an alternative first line treatment for KD patients whose parents cannot afford the high cost of IVIG.
Author Disclosures: C.B. Bernal: None. C. Cuaso: None. J. Ngo: None.
- © 2015 by American Heart Association, Inc.