Pediatric Infection and Vaccine

  • 제21권3호
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  • Pages.225-230
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  • 2014
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  • 2384-1079(pISSN)
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  • 2384-1087(eISSN)
대한소아감염학회 (The Korean Society of Pediatric Infectious Diseases)
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불응성 가와사키병 환아에서 infliximab 사용 후 발생한 패혈증

Gram-negative Septicemia after Infliximab Treatment in an Infant with Refractory Kawasaki Disease

  • 이진환 (건양대학교 의과대학 소아과학교실) ;
  • 윤정민 (건양대학교 의과대학 소아과학교실) ;
  • 임재우 (건양대학교 의과대학 소아과학교실) ;
  • 고경옥 (건양대학교 의과대학 소아과학교실) ;
  • 천은정 (건양대학교 의과대학 소아과학교실)
  • Lee, Jin Hwan (Department of Pediatrics, Konyang University College of Medicine) ;
  • Yoon, Jung Min (Department of Pediatrics, Konyang University College of Medicine) ;
  • Lim, Jae Woo (Department of Pediatrics, Konyang University College of Medicine) ;
  • Ko, Kyong Og (Department of Pediatrics, Konyang University College of Medicine) ;
  • Cheon, Eun Jung (Department of Pediatrics, Konyang University College of Medicine)
  • 투고 : 2014.07.21
  • 심사 : 2014.09.01
  • 발행 : 2014.12.25
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초록

최근 가와사키병에서 tumor necrosis factor-alpha(TNF-alpha) blocker인 infliximab 단일 정주 요법이 불응성 가와사키병 환자들에게 유용한 치료제로 여겨지고 있다. 장기적인 TNF-alpha blocker 사용이 기회감염의 위험을 증가시킬 수 있지만, 가와사키병 환자들에게 infliximab 사용이 심각한 부작용을 초래하지 않으며 안전하게 사용된 증례들이 보고된 바 있다. 불응성 가와사키병을 앓고 있는 5개월 된 영아에서 infliximab (5 mg/kg) 단일 정주 요법을 사용하였고 가와사키 증상이 호전되었으나 infliximab 치료 후 Acinetobacter lwoffii에 의한 패혈증이 발생하였다. 그래서 저자들은 불응성 가와사키병을 앓은 영아에서 infliximab 치료 후 발생한 패혈증의 첫 사례를 보고하며 infliximab 치료 선택에 있어 기회 감염의 위험성에 대해 고려할 것을 당부하는 바이다.

Kawasaki disease (KD) is an immune-mediated disease which is a leading cause of acquired cardiovascular disease in developed country. Recently, tumor necrosis factor-alpha (TNF-alpha) blocker, infliximab has been considered a promising option for patients with refractory KD. Although chronic use of a TNF-alpha blocker could increase risk of opportunistic infections, a few studies have documented that use of infliximab was safe without serious adverse effects in patients with KD. We observed serious bacterial infection after infliximab treatment in an infant with refractory KD. Our patient was a 5-month-old male infant diagnosed with KD who did not respond to repeated doses of intravenous immunoglobulin. We effectively treated him with a single infusion of infliximab (5 mg/kg), but gram-negative (Acinetobacter lwoffii) septicemia developed after infliximab infusion. Therefore, we report a case of serious septicemia after treatment with infliximab, and suggest considering the risk of severe infection when deciding whether to prescribe infliximab to an infant with refractory KD.

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