Clinical Outcomes of Initial Dexamethasone Treatment Combined with a Single High Dose of Intravenous Immunoglobulin for Primary Treatment of Kawasaki Disease

PURPOSE: To investigate the clinical effects of a single high dose intravenous immunoglobulin (IVIG) combined with initial dexamethasone as a primary treatment on Kawasaki disease (KD). MATERIALS AND METHODS: Between January 2008 and December 2010, we reviewed the medical records of 216 patients with complete KD patients that were admitted to a single medical center. 106 patients were treated with a single high dose of IVIG (2 g/kg) alone and 110 patients received IVIG and dexamethasone (0.3 mg/kg per day for three days). RESULTS: The combined IVIG plus dexamethasone patient group had a significantly shorter febrile period and duration of hospital stay (1.4+/-0.7 days vs. 2.0+/-1.2 days, p<0.001; 5.8+/-1.7 days vs. 6.9+/-2.5 days, p<0.001, respectively) than the IVIG alone group. The combined IVIG plus dexamethasone group required IVIG retreatment significantly less than the IVIG only group (12.7% vs. 32%, p=0.003). After completion of the initial IVIG, C-reactive protein levels in the combined IVIG plus dexamethasone group were significantly lower than those in the IVIG only group (2.7+/-4.0 mg/dL vs. 4.6+/-8.7 mg/dL, p=0.03). In the combined IVIG plus dexamethasone group, the incidence of coronary artery lesions tended to be lower without worse outcomes at admission after initial infusion of IVIG and in follow-up at two months; however, the differences were not significant (8.2% vs. 11.3%, p=0.22; 0.9% vs. 2.8%, p=0.29). CONCLUSION: Initial combined therapy with dexamethasone and a single high-dose of IVIG resulted in an improved clinical course, in particular a shorter febrile period, less IVIG retreatment, and shorter hospital stay without worse coronary outcomes.

The Effect of High-Dose Intravenous Immunoglobulin for the Treatment of Toxic Epidermal Necrolysis / 대한피부과학회지

BACKGROUND: Toxic epidermal necrolysis(TEN) is the most dramatic and life-threatening cutaneous drug reaction. However, specific and effective treatment for TEN have not yet been identified. Recently several reports suggested that high dose intravenous immunoglobulin(IV Ig) treatment has produced good results in patients with TEN. OBJECTIVE: To analyze the efficacy and side effects of IV Ig in treatement of TEN. METHODS: Ten patients with clinicopathological diagnosis of TEN were treated with IV Ig(1.6-3.4g/kg), and clinical efficacy and side effects were observed. RESULTS: Nine patients were healed and one died of sepsis. Interruption of further epidermal detachment occurred after an average 3 days from the onset of IV Ig therapy. Complete wound healing occurred after an average of 14.3 days. The side effects of IV Ig including headache, myalgia, nausea, transient neutropenia, and coombs positive hemolytic anemia were observed in 4 patients but normalized after cessation of IV Ig therapy. Three of them showed complete healing of detached skin but died with aggravation of underlying disease. CONCLUSION: IV Ig therapy represents a safe and very effective treatment for TEN. Furthermore, intensive care for underlying diseases is also very important for reducing the mortality rate in patients with TEN.