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Journal of the Korean Pediatric Society 2002;45(11):1411-1416.
Clinical Characteristics in Patients with Kawasaki Disease Who Received Intravenous Gamma-globulin Retreatment
Deok-Soo Kim, Yoon-Soo Hahn, Heon-Seok Han
Department of Pediatrics, College of Medicine, Chungbuk National University, Cheongju, Korea
가와사끼병에서 감마글로불린 재투여가필요했던 경우의 임상적 특징
김덕수, 한윤수, 한헌석
충북대학교 의과대학 소아과학교실
Correspondence:  Heon-Seok Han,
Email: hshan@med.chungbuk.ac.kr
Abstract
Purpose
: Although the use of intravenous gamma-globulin(IVGG) in Kawasaki disease(KD) is effective in reducing clinical symptoms and coronary artery complications, 20-30% of patients have persistent or recrudescent fever and ongoing clinical symptoms. In these patients, the additional infusion of IVGG is considered. The authors studied the characteristics of patients who received IVGG retreatment, and compared them with the patients who did not need IVGG retreatment, for determination of IVGG retreatment.
Methods
: We reviewed the medical records of 117 KD patients who could be followed up at least six months. We studied the conventional laboratory findings, electrocardiogram(EKG), signal averaged ECG(SAECG) and echocardiogram.
Results
: Twenty three patients had early cardiac complications during the six months of follow- up. Four patients had late cardiac complications after six months. The early cardiac complication rate was higher in the IVGG retreatment group than the single infusion group(P<0.0001). The late complication rate was also higher in the retreatment group(P<0.0001). The patients who received methyl-prednisolone(m-PD) pulse therapy had much higher rates of early and late cardiac complications than those who received a single IVGG infusion. Among the clinical data and laboratory findings, only CRP increased significantly in patients who have had the cardiac complications. The IVGG retreatment group had increased CRP than the single infusion group.
Conclusion
: The patients with increased initial CRP may have an increased incidence of complications and an increased possibility of IVGG retreatment. We thought that retreated KD patients might have inflammations severe enough to need high dose IVGG as shown by high CRP levels, and IVGG retreatment could not prevent coronary artery lesions sufficiently.
Key Words: Kawasaki disease, IV gamma-globulin, CRP


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