A practical approach to refractory Kawasaki disease

Kawasaki disease (KD) is a medium vessel vasculitis and is the most common cause of acquired heart disease in childhood. If left untreated, KD leads to coronary artery aneurysms in 15–25% of patients and the mortality rate in the UK is currently 0.4%. As such, KD is an important preventable cause of heart disease in the young. The aetiology of KD remains unknown, but most likely it represents an aberrant inflammatory host response to one or more as yet unidentified immunological trigger(s) in genetically predisposed individuals. The purpose of this article is not to provide an exhaustive review of KD. Rather we provide practical guidance to the clinical approach to refractory KD. Only brief background on the pathogenesis and epidemiology of KD, and emerging newer clinical trials is provided, to place our clinical approach in context.