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Pulse methylprednisolone therapy for impending cardiac tamponade in immunoglobulin-resistant Kawasaki disease
P G Dahlem1, I A von Rosenstiel, J Lam
1Division of Pediatric Intensive Care, Department of Pediatrics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. P.Dahlem@amc.uva.nl
Insights
Kawasaki disease (KD) can lead to serious heart complications like pericardial effusion and cardiac tamponade, even after initial treatment. Early recognition and appropriate management, including corticosteroids, are crucial for favorable outcomes in these rare cases.
Area of Science:
- Pediatric Cardiology
- Rheumatology
- Immunology
Background:
- Kawasaki disease (KD) is a leading cause of acquired heart disease in children.
- Standard treatment involves intravenous immunoglobulin (IVIG) and aspirin.
- Complications can arise despite initial therapeutic response.
Observation:
- A pediatric patient with KD experienced rapid improvement with IVIG and aspirin.
- Within 14 days, the patient developed a large pericardial effusion and polyserositis syndrome.
- Symptoms included impending cardiac tamponade, pleural effusions, and ascites.
Findings:
- This case represents the first report of polyserositis syndrome with impending cardiac tamponade during KD.
- Prompt treatment with pulsed methylprednisolone led to rapid resolution of effusions and ascites within 48 hours.
- The patient's clinical course highlights a rare but severe manifestation of KD.
Implications:
- Highlights the potential for delayed, severe cardiac and systemic complications in KD.
- Suggests a role for corticosteroids in managing refractory or complicated polyserositis in KD.
- Emphasizes the need for vigilant cardiac monitoring in pediatric patients with KD, even after initial treatment response.
Abstract:
We describe a boy with Kawasaki disease (KD) whose clinical course was marked by a rapid improvement upon treatment with intravenous immunoglobulin (IVIG) and oral aspirin, which - within 14 days - was followed by the development of a large pericardial effusion with symptoms of impending cardiac tamponade as part of a polyserositis syndrome (pleural effusions, ascites). Upon treatment with pulsed methylprednisolone, the pericardial and pleural effusions and ascites rapidly disappeared within 48 h. This is the first case reported with a polyserositis syndrome and impending cardiac tamponade during KD.