Approach to treatment of Kawasaki disease after initial treatment with IVIG

KD: Kawasaki disease; IVIG: intravenous immune globulin; CA: coronary artery.
* Persistent or recurrent fever of any magnitude between 36 hours to approximately 2 weeks after the start of treatment in patients with KD is generally assumed to be the result of failure to abort the disease process. Patients who have persistent or recurrent fever more than 24 hours after completion of the initial treatment should also be assessed for intercurrent infection, and the diagnosis of KD should be reevaluated. However, these patients should be treated for presumed recrudescence of KD, unless there is clear evidence of another explanation for fever.
¶ Higher-risk patients may be treated with 2 therapies sequentially or concurrently. Refer to UpToDate topic on refractory KD for details.
Δ In addition to the immunomodulatory therapies listed here, patients with large and giant CA aneurysms require additional antithrombotic therapy. For further details, refer to UpToDate topic on management of cardiovascular complications of KD.
◊ Patients with AB, A, and B blood groups are at higher risk of hemolytic anemia with IVIG retreatment.