Background Kawasaki disease (KD) is an acute systemic vasculitis of unknown aetiology and a leading cause of acquired heart disease in children in developed countries.
Purpose To describe a case of refractory KD in which abciximab was used in order to promote vascular remodelling.
Material and methods Retrospective case report and literature search related to the treatment of refractory KD.
Results The case involved a 15-month-old boy weighing 14 kg with KD whose treatment was delayed 16 days from the onset of the disease. He received aspirin at anti-inflammatory dosage (80 mg/kg/day) and intravenous immunoglobulin (IVIG) at 2 g/kg dosage. Because of failure of response after 20 days, the dose of IVIG was repeated and corticosteroids at high doses (methylprednisolone 30 mg/kg/day) were administered for 3 days.
At a later stage, fever remission was achieved by administering infliximab 5 mg/kg (off-label use). Pericardial effusion and aneurysms were observed on echocardiography study in the right coronary artery (RCA) and left anterior descending (LAD) artery, with a maximum diameter of 12 mm and 8.5 mm, respectively. On day 32, aneurysms size reduction was attempted by prescribing abciximab, that was administered as follows: 0.25 mg/kg bolus followed by a continuous infusion at the rate of 0.125 μg/kg/min. No adverse effects related to the administration of abciximab were observed. Echocardiogram track 2, 8, 12 and 20 months after administration of abciximab showed maximum diameter of the aneurysm observed in the RCA of 11, 11, 15 and 13 mm, and in the LAD 11, 9, 12 and 10 mm, respectively.
Conclusion Different studies have collected data on the use of abciximab to promote vascular remodelling in patients with coronary heart disease after KD. In our case, abciximab failed to produce aneurysm regression. Abciximab may prevent thrombotic complications. Abciximab at current dosage was well tolerated by our patient. The role of abciximab and its optimal dose in KD is not fully understood. Clinical trials are needed.
References and/or Acknowledgements
McCandless, et al. Does abciximab promote coronary artery remodeling in patients with Kawasaki disease? Am J Cardiol 2010;105:1625-8
References and/or AcknowledgementsNo conflict of interest.
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