Management and outcome of persistent or recurrent fever after initial intravenous gamma globulin therapy in acute Kawasaki disease

Objective: To determine differences in clinical characteristics, laboratory findings, and cardiac complications between patients with acute Kawasaki d isease who received additional treatment for persistent or recurrent fever vs those who did not. Design: Nonconcurrent case series; medical record review. Setting: Tertiary care pediatric hospital. Patients: One hundred eighty-five consecutive patients diagnosed as having acute Kawasaki disease at The Hospital for Sick Children, Toronto, Ontario, from 1995 to 1997. Main Outcome Measure: Prevalence of cardiac complications. Results: Twenty-one patients (11%) received additional treatment with intra venous gamma globulin (IVGG) with or without intravenous methylprednisolone for persistent fever lasting for more than 48 hours or recurrent fever aft er initial treatment with IVGG. Patients who received additional treatment did not differ significantly from other patients regarding age, sea, race, or diagnostic criteria. Compared with the patients who did not receive addi tional therapy, the patients who received additional treatment had shorter median interval from fever onset to initial dose of IVGG (5 vs 6 days; P = .006) and longer total days of fever (9 vs 6 days; P < .001). Initial labor atory investigations did not differ significantly. On initial echocardiogra phy, patients who received additional therapy were significantly more likel y to have pericardial effusion (33% vs 15%; P = .04), ventricular dysfuncti on (14% vs 2%; P = .002), and coronary artery ectasia (76% vs 43%; P = .004 ) but not aneurysms (10% vs 5%; P = .47). At 12 months after diagnosis, the re were no significant differences between the 2 groups regarding, the prev alence of coronary artery ectasia or aneurysms. Conclusion: Patients receiving additional treatment for persistent or recur rent fever have similar demographic and clinical characteristics, greater i nitial cardiac involvement, and similar overall outcomes.