• Clinical and Experimental Pediatrics
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• 제62권4호
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• pp.119-123
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• 2019

Kawasaki disease (KD) is a systemic vasculitis that mainly affects younger children. Intravenous immunoglobulin (IVIG) resistant cases are at increasing risk for coronary artery complications. The strategy on prediction of potential nonresponders and treatment of IVIG-resistant patients is now controversial. In this review the definition and predictors of IVIG-resistant KD and current evidence to guide management are discussed.

• Annals of Clinical Neurophysiology
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• 제8권1호
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• pp.6-15
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• 2006

Intravenous immunoglobulin (IVIg) is the treatment of choice for many autoimmune neuropathic disorders such as Guillain-Barre syndrome (GBS), chronic inflammatory Demyelinating neuropathy (CIDP), and multifocal motor neuropathy (MMN). IVIg is preferred because the adverse reactions are milder and fewer than the other immune-modulating methods such as steroid, other immunosuppressant such as azathioprine, and plasmapheresis. IVIg also has been used in other autoimmune neuromuscular disorders (inflammatory myopathy, myasthenia gravis, and Lambert-Eaton myasthenic syndrome) and has been known as safe and efficient agent in these disorders. Since IVIg would get more indications and be used more commonly, clinicians need to know the detailed mechanism of action, side effects, and practical points of IVIg.

• Annals of Clinical Neurophysiology
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• 제8권1호
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• pp.48-52
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• 2006

Background: Intravenous immunoglobulin (IVIg) has been administered for various immune-mediated neurological diseases such as autoimmune neuropathy, inflammatory myopathies, and other autoimmune neuromuscular disorders. The purpose of this study is to investigate side effects and complications of IVIg therapy in neuromuscular disorders. Methods: We enrolled 29 patients (age 8~63 years) with IVIg therapy for various neurological diseases including Guillain-Barre syndrome, myasthenia gravis, dermatomyositis, polymyositis, chronic inflammatory demyelinating polyneuropathy, and multifocal motor neuropathy. IVIg therapy was used at a dose of 0.4 g/kg body weight/day for 5 consecutive days. Results: 10 patients (34%) had adverse events. There are adverse events in 16 courses (11%) among total 145 courses. The majority of patients presented with mild side effects, mostly asymptomatic laboratory changes. Rash or mild headache occurred in 3 patients. One patient showed a serious side effect of deep vein thrombosis. Conclusions: IVIg therapy is safe for a variety of immune-mediated neurological diseases in our study.

• Clinical and Experimental Pediatrics
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• 제46권8호
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• pp.817-820
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• 2003

목 적 : IVIG은 다양한 면역 질환에서 면역 조절제로 사용되고 있다. 가와사끼병에서 고용량의 IVIG 투여가 단백과 지질을 포함한 다양한 생화학적 지표에 미치는 영향을 알아보고자 하였다. 방 법 : IVIG(2 g/kg)을 투여받은 12 명의 가와사끼병 환아에 대해 IVIG 투여 전, 2시간, 24시간 및 7일 후에 혈청을 분리하고 $-20^{\circ}C$에 냉동보관하였다. 대조군으로 20명의 같은 연령군의 건강한 아동 혈청을 이용하였다. 결 과 : 알부민은 IVIG 투여 2시간 및 24시간 후 유의한 감소를 보였으며, 7일 후에는 투여 전 수준으로 회복되었다. 총 콜레스테롤과 트리글리세라이드는 7일 후 증가하는 경향을 보였다. HDL-콜레스테롤과 CRP 치는 IVIG 투여 2시간과 24시간 후 유의한 감소를 보였다. 결 론: 가와사끼병 환아에 투여된 고용량의 IVIG는 단시간 내에 단백 지표들과 HDL-콜레스테롤 치의 변화를 가져온다. HDL-콜레스테롤의 변화는 전신적인 단백 대사의 변화에 의할 것으로 보인다.

• Annals of Clinical Neurophysiology
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• 제18권1호
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• pp.14-17
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• 2016

Intravenous immunoglobulin (IVIG) is a safe treatment to treat various neurological disorders, but fatal thrombotic events as rare complications have been reported. A 54-year-old woman with Guillain-Barre syndrome complained of dyspnea during IVIG treatment. She was finally diagnosed with pulmonary thromboembolism. To the best of our knowledge, this is the first case of pulmonary thromboembolism associated with IVIG treatment in a Korean patient with Guillain-Barre syndrome.

• 대한수의학회지
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• 제63권3호
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• pp.28.1-28.5
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• 2023

A 10-year-old spayed female Maltese presented with purpura and hematemesis. Initial laboratory evaluation revealed immune-mediated thrombocytopenia, but evidence of hemolytic anemia was not identified. Three milligrams of human intravenous immunoglobulin (hIVIG) was administered for 3 hours following prednisolone and mycophenolate mofetil. A pale mucous membrane was identified, and the packed cell volume decreased by 3%. Blood film examination revealed significant spherocytosis with auto-agglutination. Blood transfusions and immunosuppression were continued for 4 days, and hIVIG was discontinued. This report describes a case of increased immune-mediated hemolysis after hIVIG administration, possibly due to new-onset immune-mediated hemolytic anemia or enhanced immunogenicity.

• Clinical and Experimental Pediatrics
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• 제56권2호
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• pp.75-79
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• 2013

Purpose: It has been reported that 10% to 20% of children with Kawasaki disease (KD) will not respond to intravenous immunoglobulin (IVIG) treatment. In this study, we aimed to identify useful predictors of therapeutic failure in children with KD. Methods: We examined 309 children diagnosed with KD at the Kyungpook National University Hospital and the Inje University Busan Paik Hospital between January 2005 and June 2011. We retrospectively reviewed their medical records and analyzed multiple parameters in responders and nonresponders to IVIG. Results: Among the 309 children, 30 (9.7%) did not respond to IVIG. They had significantly higher proportion of neutrophils, and higher levels of aspartate aminotransferase, alanine aminotransferase (ALT), total bilirubin, and N-terminal fragment of B-type natriuretic peptide than did responders. IVIG-nonresponders had a significantly longer duration of hospitalization, and more frequently experienced coronary artery lesion, and sterile pyuria. No differences in the duration of fever at initial treatment or, clinical features were noted. Conclusion: Two independent predictors (ALT${\geq}$84 IU/L, total bilirubin${\geq}$0.9 mg/dL) for nonresponse were confirmed through multivariate logistic regression analysis. Thus elevated ALT and total bilirubin levels might be useful in predicting nonresponse to IVIG therapy in children with KD.

• Clinical and Experimental Pediatrics
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• 제51권2호
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• pp.204-208
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• 2008

목 적 : 본 연구는 소아 급성 ITP에서 IVIG 치료 후 호중구 감소의 빈도와 정도 및 경과 등을 알아보기 위하여 시행되었다. 방 법 : 2001년 1월부터 2006년 6월까지 부산대학교병원에서 급성 ITP로 진단받은 소아 환자 총 54례를 대상으로 하였다. 이중 IVIG를 투여한 군이 42례, Anti-D Ig을 투여한 군이 12례이었으며, 각각의 투여 후에 백혈구 및 호중구 수를 비교하였다. 또한 IVIG의 투여 방법 및 투여 횟수에 따른 백혈구 및 호중구 수도 비교하였다. 결 과 : IVIG 투여 군과 Anti-D Ig 투여 군에서 투여 직전의 백혈구 및 호중구 수의 차이는 없었으나, 투여 후에는 IVIG 투여군에서 42례 중 32례(76.2%)가 투여 전에 비해 호중구 수가 50% 이상 감소하였고, 투여 종료 후 1일째에 호중구수가 최저로 감소하였다. 한편 Anti-D Ig 투여군에서는 12례 중 2례(16.7 %)만이 투여 전 호중구 수에 비해 50% 이상으로 감소하였다. 첫 번째 IVIG 투여군(42례)과 재투여군(7례)에서 호중구 수의 감소는 통계학적인 차이가 없었다. IVIG 투여 방법에 따른 호중구 수의 감소는 5일간 투여군과 2일간 투여군 사이에 통계학적인 차이가 없었다. 면역글로불린 투여 후에 발생한 호중구 감소는 평균 투여 종료 7일 후에 39례 중 38례(97%)에서 자연적으로 회복되었다. 결 론 : 소아 ITP 환자에서 IVIG 투여 후에 호중구 감소가 비교적 흔하게 발생되며, 이는 일시적인 현상으로 대부분 자연적으로 회복되는 것으로 생각된다.

• 한국임상수의학회지
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• 제30권1호
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• pp.61-65
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• 2013

An American Cocker Spaniel (3-year-old, intact female, 6.0 kg) was referred to the Veterinary Medical Teaching Hospital of Chungnam National University for evaluation of pustules and crusts in the periocular region, dorsal and ventral region of the trunk, and digits. Complete blood count (CBC) revealed leukocytosis with mature neutrophilia, and a serum biochemistry profile revealed hypoalbuminemia. Tape strip tests identified numerous neutrophils and acatholytic cells. Histopathology identified intraepithelial pustules with neutrophils and acantholytic keratinocytes. Definitive diagnosis of pemphigus foliaceus (PF) was made by direct immunofluorescence (DIF) test with goat anti-canine IgG antibody. The human intravenous immunoglobulin (IVIG) was administered at a rate of 15 ml/h over 6 hours for 4 days. After that, the dog was maintained on prednisolone (2.2 mg/kg, PO, SID) and azathioprine (2.0 m/kg, PO, SID). An infusion of IVIG (0.5 g/kg) was repeated 3 days after 4 weeks. After 10 weeks, the dog showed the remarkable regression of lesions.

• Clinical and Experimental Pediatrics
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• 제59권12호
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• pp.477-482
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• 2016

Purpose: We conducted a study to determine which factors may be useful as predictive markers in identifying Kawasaki disease (KD) patients with a high risk of resistance to intravenous immunoglobulin (IVIG) and developing coronary artery lesions (CAL). Methods: We enrolled 287 patients in acute phase of KD at a single center. The demographic, clinical and laboratory data were collected retrospectively. Results: There were 34 patients in the IVIG resistant group. The IVIG resistant group had significantly higher serum N-terminal-pro-brain natriuretic protein (NT-proBNP) levels (P<0.01) and polymorphonuclear neutrophil (PMN) percentage (P<0.01) in comparison to the IVIG responders. The results yielded sensitivity (78.8%, 60.6%), specificity (58.2%, 90%) and cutoff value (628.6 pg/mL, 80.3%) of NT-proBNP and PMN respectively, in predicting IVIG resistance. Despite IVIG administration, 13 of the 287 patients developed CAL. The patients in the CAL group had higher NT-proBNP levels (P<0.01) and higher PMN percentage (P<0.01). In these patients, the results yielded sensitivity (73.3%, 56.7%), specificity (67.9%, 88.9%) and cutoff value (853.4 pg/mL, 80.3%) of NT-proBNP and PMN respectively, for predicting CAL. The area under the curve (AUC) for predicting resistance to IVIG was NT-proBNP 0.712, PMN 0.802. The AUC for predicting CAL was NT-proBNP 0.739, and PMN 0.773. Conclusion: Serum NT-proBNP levels and PMN percentage were significantly elevated in patients with KD with IVIG resistance and CAL. Thus, they may be useful predicting markers for IVIG resistance and development of CAL in KD patients.