Gammaglobulin Failure and Retreatment in Kawasaki Disease

Abstract

Background: Several cases of Kawasaki disease, (KD), up to 15%, were unresponsive to the initial treatment with intravenous immunoglobulin (IVIG). We retrospectively analyzed all children admitted for KD to determine the occurrence and variables associated with the initial IVIG treatment failure. Methods: All patients who fulfilled the criteria for KD and were treated with a single dose (2g/kg) of IVIG between January 1995 and December 2000 were enrolled. An analysis of patients who had initially failed to respond to IVIG and patients who had coronary artery aneurysm (CAA) was conducted. Results: A total of 113 patients were enrolled during the study period. There were 65 boys (57.5%). Thirteen patients (11.5%) were found to be unresponsive to initial IVIG treatment. Patients who were anemic (Hb 12,000/mm3), and high neutrophil count (>75%) were at risk for failure to response to a single dose of IVIG. We found no correlation between age, gender, days of starting IVIG treatment and ESR with failure of initial IVIG treatment. There were 23 patients (20.3%) who developed CAA. Male gender, lower hemoglobin ( 75%), higher ESR (>100mm/hr), prolonged fever and failure to respond to a single dose of IVIG were associated with a higher risk of developing CAA. Conclusions: The failure of a single dose of IVIG treatment could be seen in up to 11.5% of our Kawasaki patients. We found that low hemoglobin ( 12,000/mm3) and high neutrophil counts (>75%) were associated with retreatment of a second dose of IVIG.