Routine Prednisolone Does Not Prevent Coronary Lesions in Kawasaki Disease

Kawasaki disease is an acute systemic vasculitis of early childhood that carries a significant risk of long-term cardiac complications, primarily through the development of coronary artery aneurysms [1, 2]. While standard therapy with intravenous immunoglobulin and aspirin effectively reduces systemic inflammation, a notable subset of patients still develops coronary lesions, prompting a search for adjunctive treatments [3]. Corticosteroids are a mainstay for other vasculitides, but their role in the initial management of Kawasaki disease has remained highly controversial [4]. Although some data suggest that adding steroids might benefit patients with severe or high-risk disease, their utility as a routine primary therapy for all patients is unclear [5]. A large randomized trial now provides definitive evidence on whether upfront steroid therapy can protect the coronary arteries of unselected pediatric patients.