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A child with severe relapsing Kawasaki disease rescued by IL-1 receptor blockade and extracorporeal membrane oxygenation
  1. Sophie Cohen1,
  2. Carline E Tacke1,
  3. Bart Straver2,
  4. Natasja Meijer3,
  5. Irene M Kuipers2,
  6. Taco W Kuijpers1
  1. 1Pediatric Hematology, Immunology and Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands
  2. 2Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands
  3. 3Pediatric Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Taco W Kuijpers, Academic Medical Center, Pediatric Hematology, Immunology and Infectious Diseases, Amsterdam 1105 AZ, The Netherlands; t.w.kuijpers{at}amc.nl

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Kawasaki disease (KD) is an acute inflammatory vasculitis that predominantly occurs in children under 5 years of age.1 It is associated with the development of coronary artery aneurysms (CAA) in 15–25% of untreated cases.2 Standard treatment consists of high-dose intravenous immunoglobulins (IVIG) along with aspirin.3 About 15% of patients do not respond to a single dose of IVIG and need retreatment.4 When ongoing signs of active disease are present, methylprednisolone pulses are often administered.5 If there is a lack of response, alternative anti-inflammatory medication such as infliximab or plasmapheresis have been suggested in individual case series.6 ,7 We report, for the first time, the beneficial use of an interleukin-1 receptor antagonist (IL-1RA) in relapsing KD.

Case report

A 2-year-old boy was presented with persistent fever, coughing and swollen cervical lymph nodes. The boy's condition had not improved with empirical antibiotic treatment. He developed a rash, conjunctivitis and swollen extremities. Upon admission the …

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