Korean J Crit Care Med.  2014 Nov;29(4):336-340. 10.4266/kjccm.2014.29.4.336.

Kawasaki Disease with Acute Respiratory Distress Syndrome after Intravenous Immunoglobulin Infusion

• Choi YH
• Lee BJ
• Park JD
• Kim SH

• KMID: 2227743
• DOI: http://doi.org/10.4266/kjccm.2014.29.4.336

Abstract

Kawasaki disease (KD) is an acute systemic vasculitis of unknown etiology. We report a case of KD with acute respiratory distress syndrome (ARDS) after intravenous immunoglobulin (IVIG) infusion. Lung manifestations associated with KD have previously been reported in the literature. Although IVIG infusion is an effective therapy for acute KD, there are some reported complications related to IVIG infusion: hypotension, aseptic meningitis, acute renal failure, hemolytic anemia, etc. The case of KD reported here was treated with IVIG and aspirin. A few days after recovery from KD, the patient developed fever and maculopapular rash. A diagnosis of relapse KD was made and retreated with IVIG infusion. However, the patient developed ARDS four days after the second IVIG infusion. The patient recovered from ARDS after nine days of ICU care, which included high frequency oscillation ventilation with inhaled nitric oxide, steroid treatment and other supportive care.

Keyword

immunoglobulin; mucocutaneous lymph node syndrome; respiratory distress syndrome, adult

MeSH Terms

Acute Kidney Injury
Anemia, Hemolytic
Aspirin
Diagnosis
Exanthema
Fever
High-Frequency Ventilation
Humans
Hypotension
Immunoglobulins*
Immunoglobulins, Intravenous
Lung
Meningitis, Aseptic
Mucocutaneous Lymph Node Syndrome*
Nitric Oxide
Recurrence
Respiratory Distress Syndrome, Adult*
Systemic Vasculitis
Aspirin
Immunoglobulins
Immunoglobulins, Intravenous
Nitric Oxide

Figure

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  Fig. 1. A frontal chest radiograph, obtained on the first admission, shows normal finding.

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  Fig. 2. A chest radiograph, performed at the second admission, shows mild haziness in both lungs.

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  Fig. 3. A frontal chest radiograph, obtained four days after the second dose of intravenous immunoglobulin infusion, shows aggravated diffuse haziness in the whole lung field.

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  Fig. 4. Chest CT scan on admission to PICU reveals diffuse ground-glass opacities and bilateral pleural effusion. CT: computed tomography; PICU: pediatric intensive care unit.

Reference

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