Case Report A Case of Kawasaki Disease with Coronary Aneurysm Responding to the 4th IVIG Treatment

License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Kawasaki disease is an acute febrile illness that usually occurs in children younger than 5 years of age. The use of intravenous immunoglobulin (IVIG) within the first 10 days of illness has been shown to reduce the incidence of coronary artery aneurysms sig-nificantly. The relative roles of repeated doses of intravenous immunoglobulin (IVIG) are controversial in refractory Kawasaki dis-ease (KD). Most experts recommend the second retreatment with IVIG, 2 g/kg in refractory KD. However, the dose-response effect of the third or fourth IVIGwas uncertain. Although there have been a significant number of reports on new therapeutic options for refractory KD, such as steroid, infliximab, methotrexate, and other immunosuppressants, their effectiveness in reducing the preva-lence of coronary artery aneurysmswas unproven.Wepresent hereKDpatientwith small coronary artery aneurysmwho is resistant to the third IVIG and steroid pulse therapy but showed improvement immediately after the infusion of the 4th IVIG on fever day 18. 1