High-dose Intravenous Immune Globulin Retreatment in Kawasaki Disease

PURPOSE: To determine clinical features, laboratory findings and cardiac abnormalities of high- dose immune globulin(IVIG) retreatment in patients with Kawasaki disease, and to report effectiveness of retreatment. METHODS: Retrospective study of 174 children diagnosed with Kawasaki disease at Ewha Mokdong hospital from March, 1999 to July, 2001. RESULTS: Twenty(11.5%) of 174 patients were retreated with high-dose IVIG. After this, only two patients(1.1%) did not respond to IVIG retreatment. Patients with failure to respond to initial IVIG did not differ from the patients who responded to a single course of IVIG in sex, age, days of fever at initial IVIG and clinical characteristics. Compared with responders with single IVIG treatment, the patients who were retreated had significantly lower albumin(3.7 vs 3.4 g/dL, P< 0.05), higher ALT(118.2 vs 229.3 U/L, P<0.05) and CRP(8.9 vs 13.3 mg/dL, P<0.05). On echocardiography, patients who recieved IVIG retreatment were significantly more likely to have caronary abnormalities(45.0% vs 13.6%, P<0.05). CONCLUSION: Retratment with IVIG for persistent or recurrent fever was safe and effective.

Clinical Features of Atypical Kawasaki Disease

PURPOSE: To identify clinical and laboratory features of atypical Kawasaki disease(KD), and to develop criteria for early diagnosis of atypical KD patients. METHODS: All patients with KD treated at our hospital from January 1998 to June 2000 were reviewed retrospectively. RESULTS: Among a total of 167 patients, 28(16.8%) were atypical KD of which seven(25%) were infants. Among the five cardinal symptoms, oral mucosal change(96.4%) occurred most frequently, followed by conjuntivitis(57.1%) and rash(46.4%). Most notable laboratory findings were anemia, and increased erythrocyte sedementation rate(ESR) or C-reactive protein(CRP). Coronary artery abnormalities developed in seven(25.8%) atypical KD patients, compared with 14.4% in typical KD patients. We considered oral mucosal change as major criterion, and conjunctivitis, rash, hematocrit 30 mm/hr or CRP >3.1 mg/dL as minor criteria. Proposed modification in diagnostic criteria for atypical KD include fever of >or=5 days;major criterion+>or=2 minor criteria, or fever of >or=5 days+4 minor criteria. CONCLUSION: The modified diagnostic criteria has yielded a sensitivity 89.3%. Our diagnostic criteria may be used for early diagnosis of atypical KD.

A Case of Bilateral Spontaneous Tension Pneumothorax Associated with Mycoplasma pneumoniae Infection

Mycoplasma pneumoniae(M. pneumoniae) is the leading cause of pneumonia in school-age children and young adults. The clinical courses are usually mild but recently, severe cases were reported such as lung abscess, Swyer-James syndrome and adult respiratory distress syndrome. Spontaneous pneumothorax associated with M. pneumoniae infection is rare. Carlisle reported a 6-year-old patient with bilateral spontaneous pneumothorax associated with M. pneumoniae infection and Koura also reported a 18-year-old girl with repeated. M. pneumoniae pneumonia with recurrent pneumothorax. We experienced bilateral spontaneous tension pneumothorax and subcutaneous emphysema associated with M. pneumoniae infection in a 6-year-old boy who presented with dyspnea, chest pain, and neck swelling. We reported it as the first case in Korea.

A Case of Adenomyoma of the Stomach in a Child Presenting Epigastric Pain / 대한소아소화기영양학회지

Adenomyomas of the stomach are rare tumors characterised by duct/gland-like structures embedded within a smooth muscle stroma. A 5-year-old female patient was admitted to the department of Pediatrics, Ewha Womans University MokDong Hospital with the history of severe epigastric pain and vomiting for 1 day. Esophagogastroduodenoscopy showed bridging fold with central dimpling on posterior wall of prepyloric antrum. Endoscopic biopsy was nondiagnostic. The patient complained epigastric pain continuously and underwent wedge resection. Pathologic examination showed an adenomyoma of the prepyloric antrum. After wedge resection, the patient did not complain epigastric pain during the postoperative follow-up. We report an unusual case of an adenomyoma of stomach.