Infliximab Could Help Adults With Kawasaki Disease

While Kawasaki disease (KD) typically affects children, it can, in rare cases, affect adults, leading to coronary artery abnormalities and acquired heart disease. Given that the disease is rare in adults and that its etiology is not fully understood, diagnosis and treatment of KD in adults can be challenging.

Some small studies of KD in children have demonstrated that infliximab can be used as a treatment for KD that is refractory to conventional treatment and that, in children, the therapy is well tolerated. Now, a recent case report describes a case of adult-onset KD that was refractory to high-dose intravenous immunoglobulin (IVIG) but responded well to infliximab therapy.

The report describes a 24-year-old man who developed fever, diarrhea, and erythema of his lower limbs. As infection was suspected, he was given intravenous antibiotics, but they failed to benefit him, and his temperature remained elevated. After 10 days, the patient had shortness of breath, and a chest x-ray showed a 52% chest-thoracic ratio and bilateral pulmonary congestion. An electrocardiogram showed widespread ST elevations, and a transthoracic echocardiogram revealed decreased diffuse left ventricular wall motion and pericardial effusion. On day 11, he experienced peeling skin on the fingertips and arthralgia of the shoulders and wrist. On day 17, the echocardiogram showed dilation at the proximal sites of the right coronary artery and left descending artery.

Given that the patient met most of the criteria for adult-onset KD, he was diagnosed with the disease and treated with high-dose IVIG and acetylsalicylic acid on days 18 and 19. He did not respond adequately to these treatments, and his fever and arthralgia did not improve.

On day 21, the patient was given infliximab at a dose of 5 mg/kg as a single intravenous infusion. The next day, his fever resolved, and his arthralgia improved. On day 30, the patient was discharged without symptoms.

The authors of the case report conclude that, while rare, KD should be included in the differential diagnosis of an adult patients with unexplained fever, mucocutaneous changes, lymphadenopathy, and congestive heart failure. Additionally, they say, infliximab can be an effective therapy for refractory adult-onset KD.

Reference

Kawaguschi T, Rikitake Y, Tsuruda T, et al. Infliximab as an alternative therapy for refractory adult onset Kawasaki disease: a case report. Medicine (Baltimore). 2018;97(40):e12720. doi: 10.1097/MD.0000000000012720.