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Two Cases of Kawasaki-Disease Who Showed Coronary Arterial Dilatation Even after Good Response to a Single High-dose Intravenous Immunoglobulin Infusion

It is now clear that a high-dose intravenous immunoglobulin therapy (IVIG) in patients with Kawasaki disease (KD) is effective for reducing the incidence of coronary arterial lesions (CAL). But both the total dose and the dose regimens of IVIG are still controversial.In this study, we report two cases with CAL in KD. These two cases were treated with aspirin (30mg/kg/day) and a single high-dose IVIG (1g/kg/day) on 5th day of illness. IVIG reduced their body temperature immediately to less than 37.5°C on 6th day of illness, so we did not add IVIG. Although they did not get high fever, and both the counts of white blood cells and the levels of C-reactive protein decreased after IVIG, their coronary arteries dilated gradually. In one case, the diameter of anterior descending branch of left coronary dilated to 4.0mm. In the other case, that of left main coronary artery dilated to 5.8mm. We confirmed these changes regressed to normal by either 2DE or selective coronary angiography after three months of onset. These cases suggest that a single high-dose IVIG (1g/kg/day) can not prevent CAL in KD, even after good response to IVIG.