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Case Reports in Cardiology
Volume 2014 (2014), Article ID 821812, 4 pages
Case Report

A Case of Kawasaki Disease with Coronary Aneurysm Responding to the 4th IVIG Treatment

Department of Pediatrics, Eulji University Hospital, Eulji University School of Medicine, 1306, Dunsan-dong, Seo-gu, Daejeon 302-799, Republic of Korea

Received 30 December 2013; Revised 2 July 2014; Accepted 17 July 2014; Published 5 August 2014

Academic Editor: Monvadi Barbara Srichai

Copyright © 2014 Ju Young Kim and Hyun Jung Kim. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Kawasaki disease is an acute febrile illness that usually occurs in children younger than 5 years of age. The use of intravenous immunoglobulin (IVIG) within the first 10 days of illness has been shown to reduce the incidence of coronary artery aneurysms significantly. The relative roles of repeated doses of intravenous immunoglobulin (IVIG) are controversial in refractory Kawasaki disease (KD). Most experts recommend the second retreatment with IVIG, 2 g/kg in refractory KD. However, the dose-response effect of the third or fourth IVIG was uncertain. Although there have been a significant number of reports on new therapeutic options for refractory KD, such as steroid, infliximab, methotrexate, and other immunosuppressants, their effectiveness in reducing the prevalence of coronary artery aneurysms was unproven. We present here KD patient with small coronary artery aneurysm who is resistant to the third IVIG and steroid pulse therapy but showed improvement immediately after the infusion of the 4th IVIG on fever day 18.