Treatment and Diagnostic Testing
Figure 1. Key Recommendations for the Treatment of KD
KD with clinical features of
high risk for poor outcome
a
KD without clinical features of
high risk for poor outcome
a
Fever persists or
returns within 36 hours
after completion of
IVIG infusion
Fever persists or returns
within 36–48 hours
NO
NO
YES
YES
IVIG with GC or IVIG with
non-GC immunomodulatory agent
IVIG
(Good Practice Statement)
Daily monitoring for fever
at home for 1–2 weeks
Ungraded Position
Statement:
Consider treatment
with GC or non-GC
immunomodulatory agent
Daily monitoring for fever
at home for 1–2 weeks
a
Clinical features of high risk for poor outcome are any of the following : Z score of ≥2.5 for le anterior
descending or right coronary artery at the time of initial echocardiogram, age <6 months.
b
Multiple courses of IVIG can result in hemolysis. If providers have any concern for this outcome, the
use of GCs or non-GC immunomodulatory agents, specifically infliximab, is appropriate.
IVIG, intravenous immunoglobulin; GC, glucocorticoid
Second course of IVIG over GC
b
Presentation
Disease status
decision point
Assessed disease
status
Treatment option,
Conditional recommendation
Treatment option,
Strong recommendation
