Successful Infliximab Treatment for Refractory Kawasaki Disease in a Neonate: A Case Report and Literature Review. (March 2021)

• Record Type: Journal Article
• Authors: Toyokawa, Tomiko; Kogaki, Shigetoyo; Takahashi, Kunihiko; Kayatani, Futoshi
• Is Part Of: Progress in pediatric cardiology. Volume 60(2021)
• Publication Date: 2021-03
• Subjects: Kawasaki Disease -- Neonate -- Infliximab -- Plasma exchange -- Coronary artery aneurysm; Pediatric cardiology -- Periodicals; Cardiovascular Diseases -- Periodicals; Infant; Child; Cardiologie pédiatrique -- Périodiques; 618.9212005
• DOI: 10.1016/j.ppedcard.2020.101255
• Languages: English
• ISSNs: 1058-9813

Abstract

Abstract: Kawasaki disease (KD) is a condition that causes acute systemic vasculitis of medium-sized arteries, particularly the coronary arteries, leading to the development of coronary artery aneurysms as a late cardiac sequelae. Its occurrence is especially rare in the neonatal period, and only a few neonatal cases have been reported. Herein, we describe a rare case of a previously healthy, full-term, 13-day-old female infant diagnosed with complete KD. Despite its early recognition and the timely administration of intravenous immunoglobulin, the disease was refractory to treatment. Second-line treatment with intravenous immunoglobulin and intravenous prednisolone followed by cyclosporine A failed to control the systemic inflammation. Hence, the patient was finally treated with infliximab and plasma exchange therapy. During the course of treatment, echocardiography showed progressive coronary artery dilatation, and about a month later, contrast computed tomography revealed systemic artery aneurysms. We also review the existing literature on neonatal KD, with the aim of increasing awareness regarding the presentation of KD in the neonatal period. Highlights: Kawasaki disease's occurrence is especially rare in the neonate period. In neonatal patients had a higher risk of coronary artery abnormalities and death. Despite neonatal status, Kawasaki disease could be safely treated with infliximab.