Management and outcome of intravenous gammaglobulin-resistant Kawasaki disease

Introduction: This study aimed to determine the prevalence and risk of intravenous gammaglobulin (IVIG)-resistant Kawasaki disease (KD) and report the outcome of treatment in patients with persistent or recurrent fever. Methods: 70 KD patients, who received IVIG treatment (2 g/kg) at a tertiary care...

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Main Authors: Rekwan Sittiwangkul, Y. Pongprot, S. Silvilairat, C. Phornphutkul
Format: Journal
Published: 2018
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http://cmuir.cmu.ac.th/jspui/handle/6653943832/61825
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spelling th-cmuir.6653943832-618252018-09-11T08:59:46Z Management and outcome of intravenous gammaglobulin-resistant Kawasaki disease Rekwan Sittiwangkul Y. Pongprot S. Silvilairat C. Phornphutkul Medicine Introduction: This study aimed to determine the prevalence and risk of intravenous gammaglobulin (IVIG)-resistant Kawasaki disease (KD) and report the outcome of treatment in patients with persistent or recurrent fever. Methods: 70 KD patients, who received IVIG treatment (2 g/kg) at a tertiary care hospital from January 1995 to June 2004, were retrospectively reviewed. Results: Nine (13 percent) of the 70 patients failed to respond to initial treatment with IVIG. The patients who did not respond to IVIG had higher erythrocyte sedimentation rate (ESR) (104 versus 74 mm/h; p-value is 0.003), longer total days of fever (14.4 +/-3.8 versus 9.2 +/- 2.3 days; p-value is 0.003) and higher initial coronary artery lesions (CAL) (7 of 9 [77.7 percent] versus 10 of 61 [16.3 percent]; p-value is 0.001) than those who responded to initial treatment. Seven of the nine patients who were retreated with IVIG (2 g/kg) responded to the second dose. The remaining two patients (two of nine, 22 percent) had persistent fever, which subsided after two to three doses of pulse intravenous methylprednisolone. At two months follow-up, IVIG-resistant patients had higher CAL by echocardiogram than IVIG-responsive patients (33 percent versus 3.2 percent, p-value is less than 0.05). Two IVIG-resistant KD patients had delayed diagnosis and developed giant aneurysms. Conclusion: Patients with high ESR had increased risk of IVIG-resistant KD. IVIG-resistant Kawasaki patients had a higher prevalence of CAL at the acute phase and two months after onset. 2018-09-11T08:59:46Z 2018-09-11T08:59:46Z 2006-09-01 Journal 00375675 2-s2.0-33748612956 https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=33748612956&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/61825
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
topic Medicine
spellingShingle Medicine
Rekwan Sittiwangkul
Y. Pongprot
S. Silvilairat
C. Phornphutkul
Management and outcome of intravenous gammaglobulin-resistant Kawasaki disease
description Introduction: This study aimed to determine the prevalence and risk of intravenous gammaglobulin (IVIG)-resistant Kawasaki disease (KD) and report the outcome of treatment in patients with persistent or recurrent fever. Methods: 70 KD patients, who received IVIG treatment (2 g/kg) at a tertiary care hospital from January 1995 to June 2004, were retrospectively reviewed. Results: Nine (13 percent) of the 70 patients failed to respond to initial treatment with IVIG. The patients who did not respond to IVIG had higher erythrocyte sedimentation rate (ESR) (104 versus 74 mm/h; p-value is 0.003), longer total days of fever (14.4 +/-3.8 versus 9.2 +/- 2.3 days; p-value is 0.003) and higher initial coronary artery lesions (CAL) (7 of 9 [77.7 percent] versus 10 of 61 [16.3 percent]; p-value is 0.001) than those who responded to initial treatment. Seven of the nine patients who were retreated with IVIG (2 g/kg) responded to the second dose. The remaining two patients (two of nine, 22 percent) had persistent fever, which subsided after two to three doses of pulse intravenous methylprednisolone. At two months follow-up, IVIG-resistant patients had higher CAL by echocardiogram than IVIG-responsive patients (33 percent versus 3.2 percent, p-value is less than 0.05). Two IVIG-resistant KD patients had delayed diagnosis and developed giant aneurysms. Conclusion: Patients with high ESR had increased risk of IVIG-resistant KD. IVIG-resistant Kawasaki patients had a higher prevalence of CAL at the acute phase and two months after onset.
format Journal
author Rekwan Sittiwangkul
Y. Pongprot
S. Silvilairat
C. Phornphutkul
author_facet Rekwan Sittiwangkul
Y. Pongprot
S. Silvilairat
C. Phornphutkul
author_sort Rekwan Sittiwangkul
title Management and outcome of intravenous gammaglobulin-resistant Kawasaki disease
title_short Management and outcome of intravenous gammaglobulin-resistant Kawasaki disease
title_full Management and outcome of intravenous gammaglobulin-resistant Kawasaki disease
title_fullStr Management and outcome of intravenous gammaglobulin-resistant Kawasaki disease
title_full_unstemmed Management and outcome of intravenous gammaglobulin-resistant Kawasaki disease
title_sort management and outcome of intravenous gammaglobulin-resistant kawasaki disease
publishDate 2018
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=33748612956&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/61825
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