Full Text: Infliximab as a Novel Therapy for Refractory Kawasaki Disease

Infliximab as a Novel Therapy for Refractory Kawasaki Disease

JENNIFER E. WEISS, B. ANNE EBERHARD, DEVYANI CHOWDHURY, and BETH S. GOTTLIEB

ABSTRACT.

Kawasaki disease (KD) is a multisystem vasculitis of unknown etiology, with coronary artery aneurysms occurring in 25% of untreated cases. With conventional treatment of intravenous immunoglobulin (IVIG) and high dose aspirin (ASA) only 4% of patients develop coronary artery aneurysms. Children who are unresponsive present a challenge. Tumor necrosis factor-a levels peak during the acute and subacute phase of KD, especially in children who develop coronary artery aneurysms. We describe a 3-year-old male with KD and giant coronary artery aneurysms, unresponsive to multiple doses of IVIG and methylprednisolone, who was treated with infliximab. After the first dose he defervesced and his laboratory measures improved. (J Rheumatol 2004;31:808-10)

Key Indexing Terms:

KAWASAKI DISEASE
TUMOR NECROSIS FACTOR-a
CORONARY ARTERY ANEURYSM
INFLIXIMAB

From the Division of Pediatric Cardiology and Division of Pediatric Rheumatology, Department of Pediatrics, Schneider Children's Hospital, North Shore–Long Island Jewish Medical Center, New Hyde Park, New York, USA.

J.E. Weiss, MD, Fellow, Division of Pediatric Rheumatology; B.A. Eberhard, MBBS, Assistant Professor of Pediatrics; D. Chowdhury, MD, Assistant Professor of Pediatrics; B.S. Gottlieb, MD, MS, Assistant Professor of Pediatrics, Albert Einstein College of Medicine.

Address reprint requests to Dr. B. Gottlieb, Pediatric Rheumatology, Schneider Children's Hospital, 269-01 76th Avenue, New Hyde Park, NY 11040. E-mail: gottlieb@lij.edu

Submitted February 14, 2003; revision accepted October 6, 2003.