High-dose glucocorticoids are given for 2 weeks followed by anti-viral agents (such as vidarabine, PF-02341066 mw interferon-alpha and lamivudine) and then plasmapheresis. This protocol facilitates seroconversion to hepatitis B immune status, which would prevent relapse [2]. In those patients who do not have hepatitis B infection, combination therapy of cyclophosphamide and high-dose glucocorticoids (such as prednisolone 1 mg/kg/day) is usually indicated, unless patients have a favourable

prognosis as defined using the five-factor score. Oral or pulsed high-dose cyclophosphamide is given for at least 3 months and glucocorticoids are tapered over the next 4 months to a minimum of 15 mg/day [89]. Intravenous EX 527 mouse methylprednisolone is used for fulminant disease [19,26]. Short duration (6 × monthly pulses) of high-dose cyclophosphamide

is associated with higher relapse rates and lower event-free survival than long duration (12 × monthly pulses) treatment in patients with polyarteritis nodosa; however, there is no significant difference in mortality [28]. Pulsed cyclophosphamide has been used with equal efficacy to continuous oral daily cyclophosphamide in polyarteritis nodosa and had a lower incidence of adverse events over a 12-month period [89,90]. Maintenance.  Once remission is achieved, steroids can be reduced gradually to 10 mg/day or less [89]. Polyarteritis nodosa has a low relapse rate and maintenance treatment is usually not needed. In cases of relapse, maintenance treatment with azathioprine or methotrexate could be considered. Kawasaki disease is characterized by fever, bilateral non-exudative conjunctivitis, erythema of the lips and oral mucosa, indurated oedema of the dorsum of hands and feet with erythema of the palms and soles, rash and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in 15–25% of untreated children and may lead new to ischaemic heart disease or sudden death. It is a more common cause of heart disease in children than

rheumatic fever [91], but is still rare. It is likely to have an infectious cause in genetically predisposed individuals involving an antigen-driven immune response in which immunoglobulin A plasma cells play a central role [92]. Early suppression of inflammation and prevention of thrombosis will reduce the risk of potentially fatal coronary artery abnormalities to between 1 and 5%. Induction.  High-dose intravenous immunoglobulin (IVIG) plus aspirin is the standard treatment, and should be started as early as possible to reduce the risk of coronary artery rupture and sudden death [93]. The mechanism of action is unknown, but it appears to have a generalized anti-inflammatory effect involving modulation of cytokine production, neutralization of bacterial super-antigens, augmentation of T cell suppressor activity and suppression of antibody synthesis [94].