The Treatment of Kawasaki Syndrome with Intravenous Gamma Globulin

We compared the efficacy of intravenous gamma globulin plus aspirin with that of aspirin alone in reducing the frequency of coronary-artery abnormalities in children with acute Kawasaki syndrome in a multicenter, randomized trial. Children randomly assigned to the gamma globulin group received intravenous gamma globulin, 400 mg per kilogram of body weight per day, for four consecutive days; both treatment groups received aspirin, 100 mg per kilogram per day, through the 14th day of illness, then 3 to 5 mg per kilogram per day. Two-dimensional echocardiograms were interpreted blindly and independently by two or more readers. Two weeks after enrollment, coronary-artery abnormalities were present in 18 of 78 children (23 percent) in the aspirin group, as compared with 6 of 75 (8 percent) in the gamma globulin group (P = 0.01). Seven weeks after enrollment, abnormalities were present in 14 of 79 children (18 percent) in the aspirin group and in 3 of 79 (4 percent) in the gamma globulin group (P = 0.005). No child had serious adverse effects from receiving gamma globulin. We conclude that high-dose intravenous gamma globulin is safe and effective in reducing the prevalence of coronary-artery abnormalities when administered early in the course of Kawasaki syndrome. (N Engl J Med 1986; 315:341–7.), KAWASAKI syndrome is an acute illness of unknown cause that occurs predominantly in infancy and early childhood. First described in Japan in 1967, Kawasaki syndrome is now known to occur in both endemic and communitywide epidemic forms in North America, Europe, and Asia in children of all races.^{1 2 3} Coronary-artery aneurysms or ectasia develops in approximately 15 to 25 percent of children with the disease and may lead to myocardial infarction, sudden death, or chronic coronary-artery insufficiency.^4,5 Among those in whom coronary-artery abnormalities develop, angiography one to two years later reveals persistent aneurysms (with or without Stenosis or tortuosity) in approximately.