Boletín Médico del Hospital Infantil de México (Oct 2023)

Immunoglobulin-resistant Kawasaki disease

  • Bibiana Marriaga-Núñez,
  • Araceli Arellano-Valdez,
  • Juan P. Abarca-de la Paz,
  • Miguel A. Bonal-Pérez,
  • Jesús G. Montaño-Durón,
  • Fortino Solórzano-Santos

DOI
https://doi.org/10.24875/bmhim.23000078
Journal volume & issue
Vol. 80, no. 4

Abstract

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Background: Kawasaki disease is a systemic vasculitis that affects small and medium-sized vessels, primarily the coronary arteries. First-line treatment includes intravenous immunoglobulin (IVIG) and acetylsalicylic acid; however, 20% do not respond adequately despite treatment. We describe a case treated with etanercept after initial IVIG failure, showing a good response. Case report: A 5-year-old female was diagnosed with classic Kawasaki disease. Echocardiography and angiotomography revealed giant and fusiform aneurysms in the coronary arteries. A first dose of IVIG therapy was administered without improvement; after the second dose, the fever persisted, so etanercept was administered, and the fever subsided. There were no new lesions in medium-caliber vessels and the previously identified coronary lesions did not progress. Conclusions: The use of etanercept in Kawasaki disease has demonstrated a clinically favorable response. Controlled clinical trials of this drug are needed to establish it as a formal therapy in cases of initial IVIG failure.

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