Walsh & Hoyt: Treatment

Early treatment of KD to reduce the inflammatory reaction, particularly in the coronary arteries and myocardium, potentially avoids the major sequelae of aneurysm formation, hemorrhage, and thrombosis. Although KD is attributed to one or more infectious agents, antibiotics have proven ineffective in its treatment. On the other hand, the use of gamma globulin early in the course of the disease (i.e., within 57 days) is associated with a dramatic improvement in most patients. In one study, coronary artery lesions developed in 5.5% of patients who received immune gamma globulin within 7 days of the onset of clinical manifestations of KD, whereas such lesions occurred in 28% of patients whose treatment was delayed more than 10 days after the onset of manifestations. The efficacy of intravenous immune globulin is presumed to involve neutralization of the causative agent (bacterium, virus, or antigen), reduction of cytokine production, prevention of cytokine-induced vascular endothelial changes, and inhibition of anti-endothelial antibodies. The preferred dosage and administration of gamma globulin is 2 g/kg given as a single intravenous dose.