Anakinra for resistant Kawasaki disease in an infant: case report and literature review

Resistant Kawasaki has been associated with the aggressive development of large coronary aneurysms, despite prompt treatment. In this paper, we present an infant who presented with resistant Kawasaki. Although initially he seemed to defervesce after the initial administration of intravenous immunoglobulin, he developed a new onset of fever, requiring a repeat dose of immunoglobulin. Coronary aneurysms developed rapidly, necessitating a second dose of immunoglobulins and second-line treatments such as anakinra and infliximab. High titers of COVID-19 antibodies have been a confounding factor in the management of that child, as the alternative diagnosis of multisystem inflammatory syndrome in children (MIS-C) was considered. Finally, the clinical and laboratory values were more in keeping with MIS-C.