1 4 6 Wright et al. The Journal of Pediatrics Janualy 1996 9. Bartoshesky LE, Bull M, Feingold M. Corticosteroid treatment of cutaneous hemangiomas: How effective? Clin Pediatr 1978; 17:625-38. 10. Sasaki GH, Pang ChY, Wittliff JL. Pathogenesis and treatment of infant skin strawberry hemangiomas: clinical and in vitro studies of hormonal effects. Plast Reconstr Surg 1984;73:359- 70. 11. Sadan N. Treatment of hemangiomas with prednisone. Harefuah 1973;84:275-7. 12. Sadan N, Sade J, Grunebaum M. The treatment of subglottic hemangiomas of infants with prednisone. Int J Pediatr Otorhi- nolaryngol 1982;4:7-14. 13. Sadan N, Horowitz I, Choc L, Pikielny SS, Wolach B. Giant hemangioma with thrombocytopenia and osteolysis success- fully treated with prednisone. J Pediatr Orthop 1989;9:472-5. 14. Katz HP. Thrombocytopenia associated with hemangioma: critical analysis of steroid therapy. Proceedings of the XI Inter- national Congress of Pediatrics, Tokyo, 1965:336. !5. Enjolras O, Riche MC, Merland JJ, Escande JP. Management of alarming hemangiomas in infancy: a review of 25 cases. Pe- diatrics 1990;85:491-8. 16. Zweifach BW, Shorr E, Black MM. The influence of the ad- renal cortex on behavior of terminal vascular bed. Ann N Y Acad 'Sci 1953;56:626-33. 17. Wyman LC, Fulton GP, Shulman MH. Direct observations on the circulation in the hamster cheek pouch in adrenal insuffi- ciency and experimental hypercorticalism. Ann N Y Acad Sci 1953;56:643-58. 18. Stnttgen G. Vasoconstriction in response to corticosteroids ob- served in human lips. Dermatologica 1976;152(suppl 1):91- 100. 19. Folkman J. Toward a new understanding of vascular prolifer- ative disease in children. Pediatrics 1984;74:850-6. 20. Mulliken JB, Zetter BR, Folkman J. In vitro characteristics of endothelium from hemangiomas and vascular malformations. Surgery 1982;92:348-53. 21. Kushner BJ. Intralesional corticosteroid injection for infantile adnexal hemangioma. Am J Ophthalmol 1982;93:496-506. 22. Edgerton MT Jr. Steroid therapy in hemangiomas. In: Williams I-Iß, ed. Symposium on vascular malformations. St Louis: Mosby, 1983. Clinical and laboratory observations Treatment of immune globulin-resistant Kawasaki disease with pulsed doses of corticosteroids Dowain A. Wright, MD, PhD, Jane W. Newburger, MD, MPH, Anneffe Baker, RN, MSN, and Robert P. Sundel, MD From the Department of Medicine, Division of Immunology (Rheumatology), and the De- partment of Cardiology, Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetrs We describe four children with Kawasaki disease resistant to treatment with intra- venously administered immune globulin who were treated with high doses of meth- ylprednisolone. All four patients apparently responded with normalization of symptoms, and none had significant progression of coronary artery abnormalities or adverse events. We recommend pulse methylprednisolone therapy (30 mg/kg per day) during a I - to 3-day period for patients with Kawasaki disease who do not respond to intravenous immune globulin therapy or who have recrudescent disease after adequate therapy. (J PEDIATR 1996; 128:146-9) Submitted for publication May 1, 1995; accepted Aug. 18, 1995. Reprint requests: Dowain A. Wright, MD, PhD, Division of Immu- nology, Children's Hospital, 300 Longwood, Ave., Enders 8, Bos- ton, MA 02115. Copyright © 1996 by Mosby-Year Book, Inc. 0022-3476/96 $5.00 + 0 9/26/68657 Administration of intravenous immune globulin reduces both the duration of fever and the prevalence of coronary artery aneurysms when given within 10 days of the onset of Kawasaki disease. 1 Nonetheless, approximately 10% of children treated with IVIG have persistent or recrudescent fever despite IVIG treatment. 2 Although the majority of