Different subgroups regarding the absence of rescue therapy in intravenous immunoglobulin-resistant Kawasaki disease

The objective of this study is the description of clinical outcomes regarding the absence of rescue therapy of intravenous immunoglobulin (IVIG)-resistant Kawasaki disease. I investigated the clinical outcomes of 33 IVIG-resistant patients who received the initial single IVIG therapy with the delayed use of anti- inflammatory drugs (DUA). These patients were divided into two groups: 11 patients who received rescue therapies (rescue group) and 22 patients who did not receive rescue therapy (non-rescue group). One patient of rescue group developed coronary artery lesions (CAL). None of the patients of non-rescue group developed CAL. The prevalence of persistent fever between rescue and non-rescue groups at 3 days and 4 days after initial IVIG therapy was 100% vs. 77% ( P = 0.144 ) and 100% vs. 18% ( P < 0.001 ), respectively. The C-reactive protein value, neutrophil counts, serum albumin levels, and sodium levels were significantly different between two groups at median 3 days after initial IVIG therapy. Two-thirds of the IVIG-resistant patients diagnosed at 24 h after completion of the initial IVIG therapy with DUA did not develop CAL after 30 days of illness without rescue therapies. The rescue therapy at this time may lead to overtreatment.