<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1665-1146</journal-id>
<journal-title><![CDATA[Boletín médico del Hospital Infantil de México]]></journal-title>
<abbrev-journal-title><![CDATA[Bol. Med. Hosp. Infant. Mex.]]></abbrev-journal-title>
<issn>1665-1146</issn>
<publisher>
<publisher-name><![CDATA[Instituto Nacional de Salud, Hospital Infantil de México Federico Gómez]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1665-11462023000400260</article-id>
<article-id pub-id-type="doi">10.24875/bmhim.23000078</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Immunoglobulin-resistant Kawasaki disease]]></article-title>
<article-title xml:lang="es"><![CDATA[Enfermedad de Kawasaki refractaria a tratamiento con inmunoglobulina]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Marriaga-Núñez]]></surname>
<given-names><![CDATA[Bibiana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Arellano-Valdez]]></surname>
<given-names><![CDATA[Araceli]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Abarca-de la Paz]]></surname>
<given-names><![CDATA[Juan P.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Bonal-Pérez]]></surname>
<given-names><![CDATA[Miguel A.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Montaño-Durón]]></surname>
<given-names><![CDATA[Jesús G.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Solórzano-Santos]]></surname>
<given-names><![CDATA[Fortino]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Secretaría de Salud Hospital General de Zapopan ]]></institution>
<addr-line><![CDATA[Guadalajara Jalisco]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Instituto Mexicano del Seguro Social Centro Médico Nacional de Occidente Hospital de Pediatría]]></institution>
<addr-line><![CDATA[Guadalajara Jalisco]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Instituto Mexicano del Seguro Social Centro Médico Nacional de Occidente Hospital de Pediatría]]></institution>
<addr-line><![CDATA[Guadalajara Jalisco]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Instituto Mexicano del Seguro Social Centro Médico Nacional de Occidente Hospital de Pediatría]]></institution>
<addr-line><![CDATA[Guadalajara Jalisco]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af5">
<institution><![CDATA[,Secretaría de Salud Hospital General Tijuana ]]></institution>
<addr-line><![CDATA[Tijuana Baja California]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af6">
<institution><![CDATA[,Universidad Autónoma de Baja California Facultad de Medicina Mexicali ]]></institution>
<addr-line><![CDATA[Tijuana Baja California]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af7">
<institution><![CDATA[,Secretaría de Salud Hospital Infantil de México Federico Gómez Unidad de Investigación en Enfermedades Infecciosas]]></institution>
<addr-line><![CDATA[ Mexico City]]></addr-line>
<country>Mexico</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>08</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>08</month>
<year>2023</year>
</pub-date>
<volume>80</volume>
<numero>4</numero>
<fpage>260</fpage>
<lpage>264</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S1665-11462023000400260&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S1665-11462023000400260&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S1665-11462023000400260&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Background: Kawasaki disease is a systemic vasculitis that affects small and medium-sized vessels, primarily the coronary arteries. First-line treatment includes intravenous immunoglobulin (IVIG) and acetylsalicylic acid; however, 20% do not respond adequately despite treatment. We describe a case treated with etanercept after initial IVIG failure, showing a good response.  Case report: A 5-year-old female was diagnosed with classic Kawasaki disease. Echocardiography and angiotomography revealed giant and fusiform aneurysms in the coronary arteries. A first dose of IVIG therapy was administered without improvement; after the second dose, the fever persisted, so etanercept was administered, and the fever subsided. There were no new lesions in medium-caliber vessels and the previously identified coronary lesions did not progress.  Conclusions: The use of etanercept in Kawasaki disease has demonstrated a clinically favorable response. Controlled clinical trials of this drug are needed to establish it as a formal therapy in cases of initial IVIG failure.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción: La enfermedad de Kawasaki es una vasculitis sistémica que afecta los vasos de pequeño y mediano calibre con predominio de las arterias coronarias. El tratamiento de primera línea incluye inmunoglobulina intravenosa (IGIV) y ácido acetilsalicílico; a pesar del tratamiento, el 20% de los pacientes no responden adecuadamente. Se presenta un caso tratado con etanercept debido a la falla inicial a IGIV, con buena respuesta.  Caso clínico: Se trata de una paciente de 5 años de edad, a quien se diagnosticó con enfermedad de Kawasaki clásica. En ecocardiografía y angiotomografía se evidenciaron aneurismas gigantes y fusiformes en las coronarias. Se administró una primera dosis con IGIV, sin mejoría; después de la segunda dosis, la paciente persistió con fiebre, por lo que se administró etanercept, tras lo cual esta cesó. No aparecieron nuevas lesiones en vasos de mediano calibre y las lesiones coronarias previas no progresaron.  Conclusiones: Con el uso de etanercept se presentó una respuesta favorable clínicamente en la enfermedad de Kawasaki. Se requieren ensayos clínicos controlados con este fármaco para establecerlo como terapia formal en los casos de falla inicial a IGIV.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Kawasaki disease]]></kwd>
<kwd lng="en"><![CDATA[Therapeutic failure]]></kwd>
<kwd lng="en"><![CDATA[TNF&#945;]]></kwd>
<kwd lng="en"><![CDATA[Etanercept]]></kwd>
<kwd lng="en"><![CDATA[Case report]]></kwd>
<kwd lng="es"><![CDATA[Enfermedad de Kawasaki]]></kwd>
<kwd lng="es"><![CDATA[Falla terapéutica]]></kwd>
<kwd lng="es"><![CDATA[TNF&#945;]]></kwd>
<kwd lng="es"><![CDATA[Etanercept]]></kwd>
<kwd lng="es"><![CDATA[Reporte de caso]]></kwd>
</kwd-group>
</article-meta>
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