Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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Infliximab으로 치료한 난치성 가와사끼병 1례

Infliximab treatment for a patient with refractory Kawasaki disease

  • 유효정 (이화여자대학교 소아과학교실) ;
  • 이수진 (이화여자대학교 소아과학교실) ;
  • 손세정 (이화여자대학교 소아과학교실)
  • Yu, Hyo-Jung (Department of Pediatrics, College of Medicine, Ewha Womans University) ;
  • Lee, Soo-Jin (Department of Pediatrics, College of Medicine, Ewha Womans University) ;
  • Sohn, Sejung (Department of Pediatrics, College of Medicine, Ewha Womans University)
  • 투고 : 2006.03.02
  • 심사 : 2006.05.11
  • 발행 : 2006.09.15
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초록

정맥내 면역글로블린은 급성 가와사끼병의 치료에 효과적이나 약 10-20%의 환자에서 치료 실패가 보고되고 있다. 이러한 경우 면역글로블린의 재투여 또는 스테로이드나 다른 약제의 사용 등 다양한 치료방법이 시도되고 있으나 아직 이에 대한 확립된 치료 가이드라인은 없다. $TNF-{\alpha}$는 가와사끼병의 급성기, 특히 관상동맥류를 가진 환자에서 혈중농도가 크게 증가한다. 저자들은 2번의 면역글로블린 투여와 3번의 pulse methylprednisolone 치료에 반응이 없던 10개월 된 난치성 가와사끼병 환아에게 항 $TNF-{\alpha}$인 infliximab (5 mg/kg, 1회)을 투여하여 임상 호전과 더불어 항염증지표가 정상이 되고 관상동맥류 진행이 억제됨을 경험하였다.

Intravenous immunoglobulin (IVIG) infusion is an effective therapy for acute Kawasaki disease (KD). Nonetheless, approximately 10 percent to 20 percent of patients have persistent or recrudescent fever despite IVIG treatment, leading to a higher risk for coronary artery aneurysms (CAA). This unresponsiveness may pose a challenge to the clinicians. Tumor necrosis $factor-{\alpha}$ levels are elevated in the acute phase of the disease, especially in patients who develop CAA. We report a 10-month-old male with KD who failed to respond to multiple doses of IVIG and methylprednisolone and who then was treated with infliximab (5 mg/kg single dose). After infliximab treatment, he became afebrile with normalization of inflammatory markers and no further progression of CAA.

키워드

참고문헌

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