Aseptic Meningitis Secondary to High-Dose Intravenous Immunoglobulin Therapy in Kawasaki Disease

Cho, Ae Ra; Park, Jee Yoon; Kim, Kyung Hyo; Hong, Young Mi

Abstract

PURPOSE
Kawasaki disease is a multisystemic inflammatory vasculitis and associated with neurologic features such as aseptic meningitis. High-dose intravenous immunoglobulin(IVIG) is used to treat Kawasaki disease and generally considered to be safe, but rare cases of aseptic meningitis with unknown etiology have been reported. The aseptic meningitis associated with Kawasaki disease was compared with meningitis as the adverse reaction of high-dose IVIG.
METHODS
Sixteen Kawasaki disease patients with typical meningeal irritation symptoms were reviewed from January 1997 to July 2002. Group I(n=11) had meningitis associated with Kawasaki disease and Group II(n=5) had meningitis as the adverse reaction of high-dose IVIG therapy. The clinical features and hematologic and cerebrospinal fluid(CSF) findings were compared between the two groups.
RESULTS
The duration of fever was significantly longer in group I than group II. Meningeal irritation symptoms were milder in group II than group I. Hemoglobin levels were lower in group II than group I. Monocyte counts were higher in group I than group II. In the CSF analysis, neutrophil counts were significantly higher in group II than group I. Otherwise, there were no significant differences in CSF protein and sugar levels between the two groups.
CONCLUSION
Aseptic meningitis occurred in patients with Kawasaki disease after administration of high-dose IVIG. High-dose IVIG was considered to be safe in general. However, clinicians should be aware of the potential for neurologic complications such as acute aseptic meningitis in patients receiving high-dose IVIG for Kawasaki disease.