In acute Kawasaki disease, a second course of IVIG — or an alternative glucocorticoid regimen — is the standard escalation when initial therapy does not suppress fever. When that second line also fails to achieve fever resolution, clinical management must advance to a further treatment step.
A second course of IVIG (intravenous immunoglobulin) was administered — or, alternatively, a glucocorticoid regimen — but the required clinical endpoint was not met.
For patients with persistent fevers after repeated IVIG treatment, the evidence supports considering immunosuppressive therapy — either a nonglucocorticoid agent or a glucocorticoid-based approach. In severe presentations, a combination strategy may be appropriate. The specific choice of agent, sequencing, and considerations for the most serious cases are detailed in the full protocol.
DOI: 10.1002/art.42041
For patients with acute KD and persistent fevers after repeated treatment with IVIG, either nonglucocorticoid immunosuppressive therapy or glucocorticoids may be used.
Findings from studies of infliximab and cyclosporine for the treatment of refractory KD suggest some potential benefit of these agents.
Combination therapy (glucocorticoid with a nonglucocorticoid immunosuppressive agent) can be considered in severe cases, such as rapidly expanding aneurysms or imminently life-threatening disease.
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