Korean J Pediatr Infect Dis.  2008 Dec;15(2):180-187. 10.14776/kjpid.2008.15.2.180.

Characteristics of Kawasaki Disease Patients who are Unresponsive to High-dose Intravenous Immunoglobulin Therapy

• Kook DH
• Ko YM
• Lee KY
• Kim DU
• Lee KY
• Lee JS

• KMID: 2439930
• DOI: http://doi.org/10.14776/kjpid.2008.15.2.180

Abstract

PURPOSE
We wanted to determine the characteristics of patients with Kawasaki disease (KD) who were unresponsive to intravenous immunoglobulin (IVIG).
METHODS
The patients with KD were divided into two groups: the IVIG responsive group (25 cases) and the IVIG unresponsive group (14 cases). We analyzed various parameters before and after the administration of IVIG, including the complete blood cell count with the differential count (%), the erythrocyte segmentation rate (ESR), the C-reactive protein (CRP) level and the protein and lipid profiles.
RESULTS
The IVIG unresponsive group had a prolonged duration of fever and a higher incidence of CAL compared to the IVIG responsive group (P < 0.001, respectively). Before IVIG infusion, the neutrophil differential, the ESR and the CRP values were higher (P < 0.001), and the total protein and albumin values were lower in the IVIG unresponsive group (P=0.01) compared to the IVIG responsive group. After IVIG infusion, there were no significant changes in the WBC count and CRP levels in the IVIG unresponsive group. The reduction of the HDL-cholesterol levels by IVIG was more significant in the unresponsive group (P=0.02).
CONCLUSION
A more severe and prolonged inflammatory response occurred in the IVIG unresponsive group at an early stage, and this finding can be detected by such inflammatory parameters as the neutrophil count and the CRP and HDL-cholesterol levels after IVIG infusion.

Keyword

Intravenous immunoglobulin; Kawasaki disease; Coronary artery lesion; HDL-cholesterol; Nonresponder

MeSH Terms

Blood Cell Count
C-Reactive Protein
Erythrocytes
Fever
Humans
Immunization, Passive*
Immunoglobulins*
Immunoglobulins, Intravenous
Incidence
Mucocutaneous Lymph Node Syndrome*
Neutrophils
C-Reactive Protein
Immunoglobulins
Immunoglobulins, Intravenous