A Study of Patients with Kawasaki Disease who Required an Additional Immunoglobulin Therapy

The subjects were 134 patients who received an initial immunoglobulin (IVIG) therapy in the acute phase of the disease from January 1990 to December 2000; 26 cases (19.4%) were prescribed an additional dosage of IVIG. The definition of the additional administration was either one of the followings: (1) when a patient received an initial IVIG therapy continuously for more than 5 days; (2) when the dosage of IVIG was increased during prescription; (3) when a patient received re-IVIG after the initial therapy. The coronary arterial lesion (CAL) was classified into four groups: no coronary lesion (N), mild coronary dilatation (Dil), middle-sized aneurysm (ANm), large aneurysm (ANl) based on echo-cardiography around the 30th day of illness. (1) The frequency (%) of CAL with and without additional IVIG was N: 65.4 vs 89.8, Dil: 3.8 vs 5.6, ANm: 19.2 vs 2.8, and ANl: 11.5 vs 1.9. (2) Percentage of cases who received additional IVIG in each category: (a) gender: male 18.4% and female 20.7%; (b) age at onset: subjects under 1 year of age or older than 4 years or more exceeded 20% in each age group; (c) start for initial IVIG therapy was as follows: the 2nd to 4th day of illness: 41.7%, the 5th to 7th day: 10.4% and the 8th day or more: 14.3%; (d) the first dosage (mg/kg) of IVIG were 100∼350: 50.0%, 351∼900: 18.2% and 901 or more: 8.3%.The two therapeutic characteristics obtained from the observations of the patients who required an additional IVIG were: (1) the start of the initial IVIG within the 4th day of illness and (2) the lower initial dosage of IVIG. In conclusion it was advisable to start the therapy from the 5th to 7th day of illness and to give a larger initial dose (more than 901mg/kg).