Predicting which patients with Kawasaki disease will be resistant to IVIG

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Kawasaki disease is an acute febrile illness which can include an intense vascular inflammatory component and the development of coronary artery aneurysms. The use of IVIG has dramatically changed the prognosis for most patients with Kawasaki disease, but unfortunately, some patients are resistant to treatment with IVIG. It has not been possible to predict which patients are more likely to be resistant to treatment with IVIG. In this issue of The Journal, Tremoulet et al reviewed retrospective data from San Diego in 2006 when 38% of patients with Kawasaki disease were found to be resistant to IVIG treatment. Resistance was not related to the brand of IVIG used for treatment. They found a number of variables related to IVIG resistance including higher percent band counts, higher levels of C-reactive protein, and alanine aminotransferase. Unfortunately, scoring systems based on these and other factors were not sufficiently accurate to use in clinical practice. Further work will be needed to be able to predict IVIG resistance and develop appropriate clinical pathways for these patients.

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