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To the Editor, The recently published article, entitled ‘‘Extensive Coronary Aneurysms with Thrombosis in Resistant Kawasaki Disease’’by Sivakumar and Pavithran [4], concisely delineates the limitations in the treatment of Kawasaki disease (KD). There is no one accepted treatment algorithm for treatment-refractory patients, and the efficacy of infliximab as a first-line therapy adjunct has not yet been studied. Although a retrospective study showed improvement in various clinical outcomes, use of infliximab as second-line therapy is not convincingly supported by highly powered studies [5]. As this case illustrates, the treatment of KD is neither universal nor intuitive. The efficacy of infliximab in this population would perhaps be enhanced if administered at an earlier time point, especially in children who are at high risk for resistance to therapy. Children who are resistant to first-line treatment with intravenous …