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Simple febrile seizure — MCCQE Part 1 MCQ

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HardChild With FeverSimple febrile seizureMCCQE Part 1

A 4-year-old with Kawasaki disease remains febrile 36 hours after completing initial IVIG. Cultures are negative, repeat examination finds no alternative infection, haemoglobin is stable and echocardiography shows no aneurysm. What is the most appropriate next treatment?

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Correct answer: D — Give a second IVIG dose with subspecialty guidance

Persistent fever 36 hours after IVIG completion meets the practical definition of IVIG resistance after other fever causes are reassessed. These children have higher coronary-aneurysm risk and need prompt additional immunomodulation with cardiology or rheumatology input. A second IVIG dose is the most commonly used second-line treatment when haemoglobin is stable; corticosteroids, infliximab or anakinra are alternatives in selected cases. Waiting for an aneurysm loses the preventive window.

Reference: https://cps.ca/en/documents/position/kawasaki-disease; https://www.aboutkidshealth.ca/kawasaki-disease