Kawasaki Disease or Incomplete Kawasaki Disease —Normal Echocardiogram — Clinical Pathway: Emergency, Inpatient

Kawasaki Disease or Incomplete Kawasaki Disease Clinical Pathway – Emergency Department and Inpatient

Normal Echocardiogram Subsequent Treatment

Guidelines for assessment and management for patients of all ages with normal echocardiogram results (Z-scores of coronary arteries all < 2.5)

For all patients, monitor and manage as indicated based on response to initial treatment.

Response to Initial Treatment Management and/or Treatment
  • Resistant
  • Fever > 38.0
  • OR
  • Lingering clinical symptoms
    > 24-36 hours after completion of IVIG
  • Re-check labs (CBC, CRP, LFTs) before escalating therapy
  • Start PO prednisolone 2 mg/kg divided BID x 5 days then taper
  • Consult Rheumatology to guide infliximab therapy
  • Infliximab 10 mg/kg
  • Repeat labs (as above) 24 hours after completing infliximab treatment
  • Discuss timing of repeat echo with Cardiology
  • If persistent fevers/symptoms after treatment with PO prednisone/prednisolone and infliximab:
    • Re-treat with IVIG
    • Consider pulse methylprednisolone 30 mg/kg/dose (max 1 g) every 24 hrs x 3 days
    • Monitor CBC, CRP, LFTs, reticulocyte count, LDH after 24 hours
  • Responsive
  • Afebrile < 38.0
  • AND
  • clinically improving ~48 hours after completion of IVIG (or adjunctive treatment)
 Discharge