[Evaluation of unresponsiveness to standard high-dose gamma globulin therapy in Kawasaki disease].

Abstract

OBJECTIVES:

We investigated the incidence of unresponsiveness to intravenous gamma globulin (IVIG) treatment in Kawasaki disease (KD) and evaluated its relation with coronary artery involvement.

STUDY DESIGN:

The study included 20 children (13 boys, 7 girls; mean age 4.2+/-3.4 years; range 9 months to 12 years) with KD. The mean disease duration on admission was 7.3+/-2.4 days (range 5 to 14 days). Initial treatment consisted of a single dose of IVIG and high-dose of aspirin. Unresponsiveness was defined as the persistence of fever and other symptoms within the first 48 hours of treatment. All the patients were evaluated by two-dimensional echocardiography before and after treatment. The mean follow-up period was 16.5+/-2.8 months (range 9 to 24 months).

RESULTS:

Unresponsiveness was seen in five patients (25%), who received a subsequent dose of IVIG, which improved fever in two patients. The remaining three patients received high-dose methylprednisolone. One patient who showed no response to either IVIG or methylprednisolone was treated with low-dose oral methotrexate. Six patients (30%) had coronary artery involvement (4 dilatations, 2 aneurysms), five patients on admission echocardiography, and one patient on control echocardiography seven days after treatment. Of five unresponsive patients, four (80%) had coronary artery involvement on admission. Patients with coronary involvement underwent coronary angiography after a mean of one year. Five patients had normal coronary arteries, whereas no angiographic regression was observed in one patient who had a giant coronary artery aneurysm on admission and was treated with oral methotrexate.

CONCLUSION:

The incidence of unresponsiveness to treatment was markedly high in KD patients who had coronary artery involvement on admission.

• Authors: Vedide Tavli, Murat Muhtar Yilmazer, Bariş Güven, Timur Meşe, Taliha Oner, Savaş Demirpençe
• Journal: Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir (Turk Kardiyol Dern Ars) Vol. 38 Issue 1 Pg. 20-4 (Jan 2010) ISSN: 1016-5169 [Print] Turkey
• Vernacular Title: Kawasaki hastaliğinda standart yüksek doz intravenöz gama globulin tedavisine yanitsizliğin değerlendirilmesi.
• PMID: 20215838 (Publication Type: Journal Article)

Chemical References

• Immunoglobulins, Intravenous
• gamma-Globulins
• Methylprednisolone
• Methotrexate

Topics

• Age of Onset
• Child
• Child, Preschool
• Coronary Angiography
• Coronary Disease (diagnostic imaging, etiology)
• Echocardiography
• Female
• Humans
• Immunoglobulins, Intravenous (therapeutic use)
• Male
• Methotrexate (therapeutic use)
• Methylprednisolone (therapeutic use)
• Mucocutaneous Lymph Node Syndrome (complications, diagnostic imaging, drug therapy)
• Treatment Failure
• Treatment Outcome
• gamma-Globulins (therapeutic use)