İntravenöz İmmünglobulin Tedavisine Dirençli Kawasaki Vakası

Yıl 2010, Cilt: 10 Sayı: 1, 41 - 43, 01.01.2010

Sinan Mahir Kayıran Berkan Gürakan Aygün Dindar

https://doi.org/10.5222/j.child.2010.041

Öz

Kawasaki hastalığı nedeni ve patogenezi bilinmeyen akut multisistemik bir vaskülittir. Tanısı klinik bulgulara göre konulur. Bu çalışmada inatçı ateş, karın ağrısı ve ishal yakınmalarıyla başvuran ve intravenöz immünglobulin IVIG tedavisine dirençli bir vaka sunulmaktadır. Hastanın yakınmaları puls metilprednizolon tedavisi ile geriledi. Yüksek doz puls steroid tedavisinin, IVIG dirençli vakalarda alternatif bir tedavi yaklaşımı olabilecektir.

Anahtar Kelimeler

Kawasaki hastalığı, puls steroid, immünglobulin

A Case with Intravenous Immunoglobulin Resistant Kawasaki Disease

Öz

Kawasaki disease is an acute febrile multisystem vasculitis of unknown etiology and pathogenesis. The diagnosis is based on clinical features. We describe a case of intrave- nous imunoglobulins IVIG resistant Kawasaki disease presenting with persistent fever, abdominal pain and diarr- hea. The symptoms disappeared after methylprednisolone pulse therapy. We emphasize that high-dose pulse steroid may be an alternative therapeutic option in Kawasaki dise- ase which presents with failure to respond high-dose IVIG therapy

Anahtar Kelimeler

Kawasaki disease, pulse steroid, immunglobulin

Kaynakça

• 1. Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with spesific desquamation of the fingers and toes in children. Allergy 1967; 16:178-222.
• 2. Burns JC, Kushner HI, Bastian JF, et al. Kawasaki disease: a brief history. Pediatrics 2000; 106:e27.
• 3. Tezer H, Seçmeer G. Kawasaki hastalığında yenilikler. Hacettepe Tıp Dergisi 2005; 36:105-10.
• 4. Dajani AS, Taubert KA, Gerber MA, et al. Diagnosis and therapy of Kawasaki disease in children. Circulation 1993; 87:1776-80.
• 5. Wallace CA, French JW, Kahhn SJ, Sherry DD. Initial intravenous gammaglobulin treatment failure in Kawasaki disease. Pediatrics 2000; 105:e78.
• 6. Burns JC, Capparelli EV, Brown JA, Newburger JW. Glode MP. Intravenous gamma-globulin treatment and retreatment in Kawasaki disease. US/Canadian Kawasaki Syndrome Study Group. Pediatr Infect Dis J 1998; 17:1144-8.
• 7. Wright DA, Newburger JW, Baker A, Sundel RP. Treatment of immune globulin-rezistant Kawasaki disease with pulsed doses of corticosteroids. J Pediatr 1996; 128:146-9.
• 8. Raman V, Kim J, Sharkey A, Chatila T. Response of refractory Kawasaki disease to pulse steroid and cyclosporine A therapy. Pediatr Infect Dis J 2001; 20:635-7.
• 9. Kasapçopur A, Arısoy N. Kawasaki hastalığı. Türk Ped Arş 2008; Özel sayı:9-11.
• 10. Sittiwangkul R, Pongprot Y, Silvilairat S, Phornphutkul C. Management and outcome of intravenous gammaglobulinresistant Kawasaki disease. Singapore Med J 2006; 47(9): 780-4.
• 11. Sundel RP, Burns JC, Baker A, Beiser AS, Newburger JW. Gamma globulin re-treatment in Kawasaki disease. J Pediatr 1993; 123:657-9.
• 12. Hung JJ, Chiu CH. Pulse methylprednisolone therapy in the treatment of immune globulin-resistant Kawasaki disease: case report and review of the literature. Ann Trop Paediatr 2004; 24:89-93.
• 13. Shinohara M, Sone K, Tomomasa T, Morikawa A. Corticosteroids in the treatment of the acute phase of Kawasaki disease. J Pediatr 1999; 135:465-9.
• 14. Fukunishi M, Kikkawa M, Hamana K, et al. Prediction of non-responsiveness to intravenous high-dose gamma-globulin therapy in patients with Kawasaki disease at onset. J Pediatr 2000; 137:172-6.