What is the treatment for patients with kawasaki disease who are resistant to IVIG therapy?
IVIG resistance is defined as fever that occurs from 36 hours to 7 days after the end of the IVIG infusion. Between 10% and 35% of patients with KD are IVIG-resistant. There are no current consensus guidelines regarding what is the optimal therapy for patients who are IVIG-resistant. Options for therapy include administration of a second dose of IVIG (2 g/kg), infliximab (5 mg/kg), or high-dose pulse steroids (20–30 mg/kg intravenously for 3 days with or without a subsequent course and taper of oral prednisone). For patients with refractory KD who fail to respond to a second course of IVIG, infliximab, and/or steroids, other therapies to consider include anakinra, cyclosporine, or plasma exchange.