A 6-year-old child has had fever for 12 days with conjunctival injection, cracked lips with strawberry tongue, cervical lymphadenopathy (3 cm), and a diffuse polymorphous rash. 2D echocardiography shows a right coronary artery Z-score of +3.2. This patient meets criteria for Kawasaki disease. The first-line treatment and its purpose are:
- A Aspirin alone — prevents fever and joint inflammation
- B Oral prednisolone + low-dose aspirin — reduces coronary inflammation
- C IV immunoglobulin (IVIG) 2 g/kg single dose + high-dose aspirin — reduces coronary artery aneurysm risk by up to 80% ✓
- D Indomethacin + aspirin — treats associated pericarditis
Correct answer: C. IV immunoglobulin (IVIG) 2 g/kg single dose + high-dose aspirin — reduces coronary artery aneurysm risk by up to 80%
Explanation
The standard treatment for Kawasaki disease is IVIG 2 g/kg as a single infusion plus high-dose aspirin (80–100 mg/kg/day in 4 divided doses) during the febrile phase. This combination reduces the incidence of coronary artery aneurysms from approximately 25% to under 5%. Aspirin is later switched to low-dose (3–5 mg/kg/day) for antiplatelet effect during the convalescent phase. Corticosteroids are reserved for IVIG-resistant cases.
Reference: Ghai Essential Pediatrics, 10th ed.
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