How should I manage a patient with Kawasaki Disease who presents with persistent fever despite initial treatment?

Management of a patient with Kawasaki disease who presents with persistent fever despite initial treatment:

Persistent fever beyond 5 days in a child with Kawasaki disease suggests ongoing inflammation and risk of coronary artery abnormalities, especially in children under 1 year who may present with fewer clinical features but higher risk.

Initial treatment typically includes intravenous immunoglobulin (IVIG) and aspirin; however, if fever persists despite initial treatment, the patient should be urgently referred to secondary care for specialist paediatric assessment and management.

Further management may include additional doses of IVIG, corticosteroids, or other immunomodulatory therapies as guided by paediatric specialists to reduce inflammation and prevent coronary artery complications.

Close monitoring for cardiac involvement with echocardiography is essential during follow-up.

Supportive care includes managing fever and distress with paracetamol or ibuprofen, ensuring adequate hydration, and monitoring for signs of serious illness or complications.