Hypersensitivity reaction to aspirin accompanied by severe eosinophilia in a child with history of Kawasaki disease

Drug hypersensitivity is one of drug adverse reactions that develop in susceptible patients following exposure to certain drugs and cannot be predicted from the known pharmacology of a drug. Severe hypersensitivity is associated with high morbidity and mortality. Although the issue of hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) has been largely investigated in adults, data related to NSAIDs hypersensitivity is insufficient in childhood. And in spite of the recommendation to avoid use of aspirin due to Reye syndrome in children, aspirin is one of major treatment along with intravenous immunoglobulin in Kawasaki disease. We report a case of a 10-month-old boy who underwent intravenous immunoglobulin and aspirin treatment for Kawasaki disease, and subsequently revealed severe leukocytosis and eosinophilia. To our knowledge, there have been no previous reports of aspirin-induced eosinophilia in Korea.

Prediction of Intravenous Immunoglobulin Nonresponse Kawasaki Disease in Korea / 소아감염

PURPOSE: The objective of this study was to find the predictors and generate a prediction scoring model of nonresponse to intravenous immunoglobulin in patients with Kawasaki disease. METHODS: We examined 573 children diagnosed with KD at the Severance Children's Hospital between January 2009 and december 2012. We retrospectively reviewed their medical records. These patients were divided into 2 groups; the experimental group (N=433) and the validation group (N=140). Each group were divided into 2 groups the intravenous immunoglobulin nonresponders and the responders. Multivariate logistic regression analysis identified predictive factors of intravenous immunoglobulin nonresponders which make predictive scoring model. We practice internal validation and external validation. RESULTS: Multivariate logistic regression analysis identified male, cervical lymphadenopathy, changes of the extremities, platelet, total bilirubin, alkaline phophatase, lactate dehydrogenase, C-reactive protein as significant predictors for nonresponse to intravenous immunoglobulin. We generated prediction score assigning 1 point for (1) male, (2) cervical lymphadenopathy, (3) changes of the extremities, (4) platelet ( or =0.4 mg/dL), (6) alkaline phophatase (> or =227 IU/L), (7) lactate dehydrogenase (> or =268 IU/L), (8) C-reactive protein (>77.1 mg/dL). Using a cut-off point of 4 and more with this prediction score, we could identify the intravenous immunoglobulin nonresponder group. Sensitivity and specificity were 52.5% and 82.4% in experimental group and 37.8% and 81.8% in validation group, respectively. CONCLUSION: Our predictive scoring models had high specificity and low sensitivity in Korean patients. Therefore it is useful in predicting nonresponse to intravenous immunoglobulin with Kawasaki disease.

Factors that predict a positive response on gonadotropin-releasing hormone stimulation test for diagnosing central precocious puberty in girls

PURPOSE: The rapid increase in the incidence of precocious puberty in Korea has clinical and social significance. Gonadotropin-releasing hormone (GnRH) stimulation test is required to diagnose central precocious puberty (CPP), however this test is expensive and time-consuming. This study aimed to identify factors that can predict a positive response to the GnRH stimulation test. METHODS: Clinical and laboratory parameters, including basal serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol (E2), were measured in 540 girls with clinical signs of CPP. RESULTS: Two hundred twenty-nine of 540 girls with suspected CPP had a peak serum LH level higher than 5 IU/L (the CPP group). The CPP group had advanced bone age (P<0.001), accelerated yearly growth rate (P<0.001), increased basal levels of LH (P=0.02), FSH (P<0.001), E2 (P=0.001), and insulin-like growth factor-I levels (P<0.001) compared to the non-CPP group. In contrast, body weight (P<0.001) and body mass index (P<0.001) were lower in the CPP group. Although basal LH was significantly elevated in the CPP group compared to the non-CPP group, there was considerable overlap between the 2 groups. Cutoff values of basal LH (0.22 IU/L) detected CPP with 87.8% sensitivity and 20.9% specificity. CONCLUSION: No single parameter can predict a positive response on the GnRH stimulation test with both high sensitivity and specificity. Therefore, multiple factors should be considered in evaluation of sexual precocity when deciding the timing of the GnRH stimulation test.