A 4-year-old boy has 7 days of fever, bilateral non-purulent conjunctivitis, strawberry tongue, erythema and desquamation of the palms and soles, cervical lymphadenopathy (2.5 cm), and maculopapular rash. Echocardiography shows left anterior descending artery Z-score of +3.2. What is the treatment of choice?
- A IVIG 2 g/kg single dose + aspirin 30–50 mg/kg/day (anti-inflammatory dose) ✓
- B Oral prednisolone 2 mg/kg/day for 2 weeks
- C IV methylprednisolone 30 mg/kg/day for 3 days
- D Aspirin 100 mg/kg/day alone
Correct answer: A. IVIG 2 g/kg single dose + aspirin 30–50 mg/kg/day (anti-inflammatory dose)
Explanation
Kawasaki disease is treated with IV immunoglobulin (IVIG) 2 g/kg as a single infusion within 10 days of fever onset, combined with high-dose aspirin (anti-inflammatory: 30–50 mg/kg/day in 4 divided doses in India, or 80–100 mg/kg/day by North American protocols) until fever resolves for 48–72 hours, then switched to low-dose aspirin (3–5 mg/kg/day) for 6–8 weeks. This Z-score of +3.2 indicates a small coronary artery aneurysm (Z ≥2.5 = aneurysm). Steroids are used only in IVIG-resistant Kawasaki disease. Aspirin alone is insufficient to prevent coronary complications.
Reference: Ghai Essential Pediatrics, 10th ed.
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