A 6-year-old child is diagnosed with Kawasaki disease. After 2 days of high-dose aspirin and IVIG, he remains febrile. Which of the following is the most appropriate next step?

• A Add oral prednisolone
• B Switch to infliximab
• C Increase aspirin to 100 mg/kg/day
• D Repeat IVIG infusion (2 g/kg) ✓

Explanation

IVIG resistance (persistent or recurrent fever ≥36 hours after completing IVIG infusion) occurs in 10–15% of Kawasaki disease patients. The initial management for IVIG-resistant Kawasaki disease is a second dose of IVIG (2 g/kg). If the child remains refractory after a second IVIG dose, corticosteroids (prednisolone) or infliximab are considered as rescue therapy. Simply increasing aspirin dose is not evidence-based for IVIG resistance.

Reference: Ghai Essential Pediatrics, 10th ed.

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