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Treatment of Kawasaki disease with corticosteroid.

1996; Elsevier BV; Volume: 129; Issue: 3 Linguagem: Inglês

10.1016/s0022-3476(96)70104-x

1097-6833

Makoto Shinohara, Katsuhiko Sone, Tomio Kobayashi, Toshihiro Kobayashi, Takashi Kosuda, Yasunori Okada,

Mechanical Circulatory Support Devices

We read with interest the article by Wright et al.1Wright DA Newburger JW Baker A Sundel RP. Treatment of immune globulin-resistant Kawasaki disease with pulsed doses of corticosteroids.J Pediatr. 1996; 128: 146-149Abstract Full Text Full Text PDF PubMed Scopus (221) Google Scholar They reported that pulsed doses of steroids were effective in four cases of Kawasaki disease (KD) resistant to intravenous gammaglobulin therapy. Here we describe our own experience with corticosteroid therapy in KD and its current status in Japan. In our institution, 158 patients with KD were treated with prednisolone and aspirin from 1982 to 1990. Dilation of the coronary arteries developed in 28 cases (17.8%) and giant aneurysms (≥8 mm in diameter) were observed in only 4 cases (2.4%). Since 1990, 71 cases (40 male patients and 31 female patients) with KD were treated with a predetermined protocol. The treatment with aspirin (30 mg/kg every day), dipyridamole (2 mg/kg every day), propranolol (1 mg/kg every day), and prednisolone (2 mg/kg every day) was started within 9 days of the onset of illness.2Shinohara M Sone K Tabata H Kobayashi T Kobayashi T Kosuda T et al.Assessment of drug therapy with aspirin, prednisolone, γ-globulin and these combination for the acute stage of Kawasaki disease [in Japanese].Kitakanto Med J. 1996; 46: 249-256Crossref Scopus (4) Google Scholar Prednisolone was administered for 3 weeks, during which the dose was reduced every week. In the severe cases (n = 39) we added intravenous gammaglobulin therapy (200 mg/kg every 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,3Harada K Intravenous γ-globulin treatment in Kawasaki Disease.Acta Paediatr Jpn. 1991; 33: 805-810Crossref PubMed Scopus (198) Google Scholar (3) development of a coronary abnormality was expected, or (4) persistent or recrudescent fever at 48 hours after treatment with prednisolone.) Mild coronary artery abnormalities developed in 11 of 71 cases (15.5%), and only one case (1.4%) had a moderate abnormality (4.0 to 8.0 mm, maximal diameter was 5.0 mm in segment 1). None of the patients had giant aneurysms. The use of corticosteroid therapy in KD is still controversial. As Wright et al. pointed out, the previous report (Kato et al.4Kato H Koike S Yokoyama T. Kawasaki disease: effect of treatment on coronary involvement.Pediatrics. 1979; 63: 175-179PubMed Google Scholar) that indicated a high incidence of coronary aneurysms in patients treated with corticosteroid was based on a small number of patients (n = 17), and it was challenged by later reports that were rather contradictory. Kijima et al.5Kijima Y Kamiya T Suzuki A et al.Trial procedure to prevent an aneurysm formation of the coronary arteries by steroid pulse therapy in Kawasaki disease.Jpn Circ J. 1982; 46: 1239-1242Crossref PubMed Scopus (66) Google Scholar described pulsed steroid therapy in KD that was beneficial in the prevention of coronary artery aneurysms. In Japan, though a majority of pediatricians are still hesitant to use corticosteroid, most do not deny its effectiveness. In addition to our hospital, one Japanese institute has been using corticosteroid aggressively and has reported that 45 (17.6%) of 255 cases had coronary abnormalities, including 3 (1.2%) with giant aneurysms (Kan et al.6Kan Z Hoshino K Ogawa K Kato K Fujiwara Y Hamada R et al.Steroid-aspirin combination therapy for treatment of Kawasaki disease (in Japanese).J Pediatr Pract. 1990; 53: 328-331Google Scholar). Although their study and ours were not controlled, the results were comparable with average outcome in Japan. We agree with Wright et al. that the effectiveness of corticosteroid in the treatment of KD should be reevaluated. 9/35/74513