Current Real-World Outcomes of Recurrent Kawasaki Disease

Toshimasa Nakada

doi:10.47752/sjmh.310.87.92

Abstract

Studies have shown that recurrent Kawasaki disease (KD) is a risk factor for resistance to initial intravenous immunoglobulin (IVIG) therapy and development of coronary artery lesions (CALs). However, current real-world outcomes of recurrent KD patients remain unclear. The objective of this retrospective study was to elucidate the outcomes of recurrent KD patients in the era of 2 g/kg IVIG therapy. Data were included from 201 KD patients who underwent acute-phase treatment from January 2009 to September 2020, with 184 (91.5%) receiving 2 g/kg IVIG therapy. The patients were divided into 7 with (recurrent group) and 194 without (nonrecurrent group) recurrent KD. At the first onset, the rates of initial IVIG therapy resistance (28.6% vs. 21.5%, P = 1.000), rescue therapy (14.3% vs. 14.4%, P = 1.000), and CALs (0.0% vs. 2.6%, P = 1.000) were similar between the recurrent and nonrecurrent groups. The rates of initial IVIG therapy resistance (14.3% vs. 21.5%, P = 1.000), rescue therapy (14.3% vs. 14.4%, P = 1.000), and CALs (0.0% vs. 2.6%, P = 1.000) were also similar between the recurrent group at the second onset and the nonrecurrent group at the first onset. KD recurrence may no longer be a risk factor for developing CALs in the era of 2 g/kg IVIG therapy, unless CALs appear at the initial episode.

Highlights

Kawasaki disease (KD) is a form of acute febrile systemic vasculitis that primarily affects children younger than 5 years [1]
KD recurrence may no longer be a risk factor for developing coronary artery lesions (CALs) in the era of 2 g/kg intravenous immunoglobulin (IVIG) therapy, unless CALs appear at the initial episode
An epidemiological study suggested that KD recurrence is no longer a risk factor for developing cardiac complications, unless cardiac sequelae appear at the initial episode [8]

Summary

Introduction

Kawasaki disease (KD) is a form of acute febrile systemic vasculitis that primarily affects children younger than 5 years [1]. Coronary artery lesions (CALs) are a severe complication of KD. Recurrent KD is defined as a recurring presentation of another episode after 2 months from the first one [2, 3]. The incidence of recurrence is high among those with cardiac sequelae during the first episode [2, 3]. Studies have shown that recurrent KD is a risk factor for CAL development [2,3,4,5,6,7]. An epidemiological study suggested that KD recurrence is no longer a risk factor for developing cardiac complications, unless cardiac sequelae appear at the initial episode [8]

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Discussion

Conclusion