Clinical and Laboratory Observation
Resistant Kawasaki Disease Treated with Anti-CD20

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We report the case of a 6-year-old boy who had Kawasaki disease resistant to intravenous immunoglobulin and systemic steroids. Because of an uncontrolled disease course, with significant lesions of the coronary arteries, anti-CD20 treatment was used. Rapid clinical, biological, and cardiac improvement was observed. The patient tolerated the treatment well.

Section snippets

Case Report

A 6-year-old child with a fever was admitted for a marked cervical lymphadenopathy, stiff neck, and trismus evolving in a 4-day period, despite being given antibiotics. A discreet perineal eruption was found. Blood analysis results showed leukocytosis (13.4 G/L), with predominance of neutrophils (10.92 G/L) and elevated acute phase reactants with C-reactive protein level of 53 mg/L and fibrinogen level of 7.91 g/L.

On the next day, a non-purulent conjunctivitis with uveitis and cheilitis

Discussion

Because of the resistance to the IVIG treatment, as proposed by the 2004 guidelines,2 we decided to start steroid therapy.3 In case of failure, like in our case report, immunomodulatory treatments would also have been discussed, on the basis of the supposed physiopathology of KD, with production of proinflammatory cytokines (interleukin [IL] 1), TNF-α, and interferon gamma), and endothelial cell activation.4 Methotrexate inhibits the production of leukotrienes and leads to a diminution of the

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There are more references available in the full text version of this article.

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    No reactivity occurs when KD patients are tested with other intradermal antigens.59 Findings of the oropharyngeal mucosa in KD can take many forms, including dryness and fissuring of the lips, erythema of the lips (Figs 4 and 7), oral cavity, buccal mucosa, and pharyngeal mucosa, nonexudative inflammation of the throat, and strawberry tongue.3,10,45-47,62 Just 1 of these findings is sufficient to meet this diagnostic criterion.

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The authors declare no conflicts of interest.

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