A 4-year-old presents with 6 days of fever, cracked lips, strawberry tongue, bilateral conjunctival injection, polymorphous rash on the trunk, and unilateral cervical lymphadenopathy >1.5 cm. Echocardiography shows left anterior descending coronary artery Z-score of +3.1. What is the most important treatment to prevent further coronary involvement?

• A IVIG 400 mg/kg/day for 5 days + low-dose aspirin
• B High-dose methylprednisolone + aspirin only
• C IVIG 2 g/kg + infliximab for resistant disease
• D IVIG 2 g/kg single dose + aspirin 30–50 mg/kg/day ✓

Explanation

Kawasaki disease with coronary artery involvement is treated with IVIG 2 g/kg as a single infusion plus high-dose aspirin (30–50 mg/kg/day in four divided doses) in the acute phase for anti-inflammatory effect. Once fever resolves for 48–72 hours, aspirin is reduced to low-dose (3–5 mg/kg/day) for antiplatelet effect, continued until coronary arteries normalize. IVIG 400 mg/kg/day for 5 days (Modick regimen) is less effective than the single 2 g/kg dose. Infliximab and steroids are reserved for IVIG-refractory Kawasaki disease.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.