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Kumrah R, Jindal AK, Rawat A, Singh S. Proteomics approach for biomarker discovery in Kawasaki disease. Expert Rev Clin Immunol 2024. [PMID: 39041312 DOI: 10.1080/1744666x.2024.2383236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/18/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Kawasaki disease (KD) is a medium vessel vasculitis mainly affecting children below the age of 5. KD is the leading cause of acquired heart disease in developed countries. Diagnosis of KD is clinical and there are no pathognomonic laboratory tests to confirm the diagnosis. There is paucity of studies that have utilized proteomic approach for biomarker discovery in KD. Identification of these biomarkers may be helpful for early and more effective diagnosis and may aid in the treatment of KD. AREA COVERED The present review focuses on studies that have utilized the proteomic approach in identification of biomarkers in patients with KD. We have divided these biomarkers into 3 different categories, the biomarkers used for (A) Assessment of risk of KD; (B) Assessment of risk of CAAs; and (C) for assessment of treatment resistance. EXPERT OPINION Efforts to improve the clinical and diagnostic evaluation of KD have focused on general markers of inflammation which are not specific for KD. Identification of a proteomic based biomarker can reliably and specifically differentiate KD from other disease and would help in the prompt diagnosis. Comprehensive analysis of serum proteome of patients with KD may be helpful in identifying candidate protein biomarkers.
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Affiliation(s)
- Rajni Kumrah
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Kumar Jindal
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Rawat
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Shen M, Liu D, Ye F, Zhang J, Wang J. Kawasaki disease in neonates: a case report and literature review. Pediatr Rheumatol Online J 2024; 22:23. [PMID: 38287358 PMCID: PMC10823709 DOI: 10.1186/s12969-024-00959-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/17/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute systemic vasculitis of unknown etiology that affects infants and young children but is extremely rare in neonates, especially afebrile KD. We present a case of KD without fever in a neonate and review the literature on KD in neonates. CASE PRESENTATION A newborn female was hospitalized because her peripheral blood leukocytes increased for half a day. The admission diagnosis was considered neonatal sepsis and bacterial meningitis. She had no fever since the admission, but a rash appeared on her face by the 7th day. On day 11 after admission, there was a desquamation on the distal extremities. On day 15 after admission, ultrasound showed non-suppurative cervical lymphadenopathy. Echocardiogram revealed coronary artery aneurysms in both sides. Finally, the patient was diagnosed with incomplete KD (IKD). The follow-up echocardiogram showed that the internal diameter of both coronary arteries returned to normal three months after birth. CONCLUSIONS Fever, rash, and distal extremity desquamation during the recovery phase are the most common symptoms of IKD. When newborns present with clinical manifestations such as rash, distal extremity desquamation and cervical lymph adenitis and with an increased peripheral blood leukocyte count and progressive increase in platelets simultaneously, the medical staff should be highly alert to the possibility of KD even without fever. The echocardiogram needs to be performed promptly. The incidence of coronary artery lesions is significantly higher if neonatal KD patients miss timely diagnosis and treatment.
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Affiliation(s)
- Mingjun Shen
- Department of Clinical Medicine, Beijing University of Chinese Medicine, Beisanhuan East Road, Chaoyang District, 100029, Beijing, China
- Department of Pediatrics, China-Japan Friendship Hospital, 2 Yinghuayuan East Street, Chaoyang District, 100029, Beijing, China
| | - Die Liu
- Department of Pediatrics, China-Japan Friendship Hospital, 2 Yinghuayuan East Street, Chaoyang District, 100029, Beijing, China
| | - Fang Ye
- Department of Pediatrics, China-Japan Friendship Hospital, 2 Yinghuayuan East Street, Chaoyang District, 100029, Beijing, China
| | - Jing Zhang
- Department of Pediatrics, China-Japan Friendship Hospital, 2 Yinghuayuan East Street, Chaoyang District, 100029, Beijing, China.
| | - Jun Wang
- Department of Clinical Medicine, Beijing University of Chinese Medicine, Beisanhuan East Road, Chaoyang District, 100029, Beijing, China.
- Department of Pediatrics, China-Japan Friendship Hospital, 2 Yinghuayuan East Street, Chaoyang District, 100029, Beijing, China.
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Yuan H, Tian J, Wen L. Serum Interleukin-6 and Serum Ferritin Levels Are the Independent Risk Factors for Pneumonia in Elderly Patients. Crit Rev Immunol 2024; 44:113-122. [PMID: 38618733 DOI: 10.1615/critrevimmunol.2024051340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Pneumonia is a common infection in elderly patients. We explored the correlations of serum interleukin-6 (IL-6) and serum ferritin (SF) levels with immune function/disease severity in elderly pneumonia patients. Subjects were allocated into the mild pneumonia (MP), severe pneumonia (SP), and normal groups, with their age/sex/body mass index/ disease course and severity/blood pressure/comorbidities/medications/prealbumin (PA)/albumin (ALB)/C-reactive protein (CRP)/procalcitonin (PCT)/smoking status documented. The disease severity was evaluated by pneumonia severity index (PSI). T helper 17 (Th17)/regulatory T (Treg) cell ratios and IL-6/SF/immunoglobulin G (IgG)/Th17 cytokine (IL-21)/Treg cytokine (IL-10)/PA/ALB levels were assessed. The correlations between these indexes/independent risk factors in elderly patients with severe pneumonia were evaluated. There were differences in smoking and CRP/PCT/ALB/PA levels among the three groups, but only CRP/ALB were different between the MP/SP groups. Pneumonia patients exhibited up-regulated Th17 cell ratio and serum IL-6/SF/IL-21/IL-10/IgG levels, down-regulated Treg cell ratio, and greater differences were noted in severe cases. Serum IL-6/SF levels were positively correlated with disease severity, immune function, and IL-21/IL-10/IgG levels. Collectively, serum IL-6 and SF levels in elderly pneumonia patients were conspicuously positively correlated with disease severity and IL-21/IL-10/IgG levels. CRP, ALB, IL-6 and SF levels were independent risk factors for severe pneumonia in elderly patients.
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Affiliation(s)
- Hao Yuan
- Department of Pulmonary and Critical Care Medicine, The Fourth Hospital of Changsha, Changsha City, Hunan Province, China
| | - Jing Tian
- Department of Pulmonary and Critical Care Medicine, The Fourth Hospital of Changsha, Changsha City, Hunan Province, China
| | - Lu Wen
- The Fourth Hospital of Changsha
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Qiu Z, Liu HH, Fan GZ, Chen WX, Hu P. The clinical implications of serum ferritin in Kawasaki disease: a helpful biomarker for evaluating therapeutic responsiveness, coronary artery involvement and the tendency of macrophage activation syndrome. Arch Med Sci 2022; 18:267-274. [PMID: 35154547 PMCID: PMC8826798 DOI: 10.5114/aoms/144293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/27/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Serum ferritin (SF) is an acute-phase reactant in inflammatory diseases. Our aim was to analyze the clinical implications of SF in Kawasaki disease (KD). METHODS 244 KD children were divided into 6 subgroups. SF, inflammatory mediators and blood cell counts were detected. RESULTS (1) SF dramatically increased in the acute phase of KD and maintained after IVIG therapy; (2) SF increased in IVIG-nonresponsive KD patients (AUC = 0.705; sensitivity: 57.10%; specificity: 82.90%); SF positively correlated with the internal diameter of the coronary artery (AUC = 0.603; sensitivity: 92.30%; specificity: 37.70%); (3) SF increased in 4 patients with the macrophage activation syndrome (MAS)/MAS tendency (979.03 ±474.19 μg/l). CONCLUSIONS SF is implied to be a helpful biomarker for forecasting IVIG-nonresponsive KD, coronary artery abnormalities (CAAs) and MAS tendency.
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Affiliation(s)
- Zhen Qiu
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hui Hui Liu
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Guo Zhen Fan
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wei Xia Chen
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Peng Hu
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, China
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Kim SH, Song ES, Yoon S, Eom GH, Kang G, Cho YK. Serum Ferritin as a Diagnostic Biomarker for Kawasaki Disease. Ann Lab Med 2021; 41:318-322. [PMID: 33303717 PMCID: PMC7748097 DOI: 10.3343/alm.2021.41.3.318] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/05/2020] [Accepted: 11/28/2020] [Indexed: 12/19/2022] Open
Abstract
Diagnosis of Kawasaki disease (KD) is occasionally delayed because it is solely based on clinical symptoms. Previous studies have attempted to identify diagnostic biomarkers for KD. Recently, patients with KD were reported to have elevated serum ferritin levels. We investigated the usefulness of the serum ferritin level as a diagnostic biomarker for distinguishing KD from other acute febrile illnesses. Blood samples were obtained from pediatric patients with KD (N=77) and those with other acute febrile illnesses (N=32) between December 2007 and June 2011 for measuring various laboratory parameters, including serum ferritin levels. In patients with KD, laboratory tests were performed at diagnosis and repeated at 2, 14, and 56 days after intravenous immunoglobulin treatment. At the time of diagnosis, serum ferritin levels in patients with KD (188.8 μg/L) were significantly higher than those in patients with other acute febrile illnesses (106.8 μg/L, P=0.003). The serum ferritin cut-off value of 120.8 μg/L effectively distinguished patients with KD from those with other acute febrile illnesses, with a sensitivity and specificity of 74.5% and 83.3%, respectively. Serum ferritin may be a useful biomarker to distinguish KD from other acute febrile illnesses.
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Affiliation(s)
- Sung Hoon Kim
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Eun Song Song
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Somy Yoon
- Department of Pharmacology and Medical Research Center for Gene Regulation, Chonnam National University Medical School, Hwasun-gun, Jeollanam-do, Korea
| | - Gwang Hyeon Eom
- Department of Pharmacology and Medical Research Center for Gene Regulation, Chonnam National University Medical School, Hwasun-gun, Jeollanam-do, Korea
| | - Gaeun Kang
- Division of Clinical Pharmacology, Chonnam National University Hospital, Gwangju, Korea
| | - Young Kuk Cho
- Department of Pediatrics, College of Medicine Chosun University, Gwangju, Korea
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Li C, Du Y, Wang H, Wu G, Zhu X. Neonatal Kawasaki disease: Case report and literature review. Medicine (Baltimore) 2021; 100:e24624. [PMID: 33607798 PMCID: PMC7899894 DOI: 10.1097/md.0000000000024624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/14/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Kawasaki Disease (KD) is a self-limiting and acute systemic vasculitis of childhood that leads to coronary artery abnormality in about 25% of untreated cases. KD is extremely rare in neonates. The purpose of this paper is to explore the clinical features and diagnosis and treatment of Neonatal Kawasaki Disease for early identification. PATIENT CONCERNS A 24-day-old male with 3 hours fever and a rash was admitted to our hospital. DIAGNOSES He had a fever, rash, cracking of lips, lymph node enlargement in the neck, and distal extremity desquamation. INTERVENTIONS The patient was given intravenous immunoglobulin and aspirin with no complications. OUTCOMES After discharge, the patient was followed up to 1 year old, with good prognosis and no carditis or coronary artery abnormalities. LESSONS Neonatal Kawasaki disease is extremely rare, and its clinical manifestation is not typical and easy to be missed. If not treated early, it will potentially give rise to coronary artery aneurysms or expansion, ischemic heart disease, and sudden death. Early diagnosis and treatment are very important.
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Severe COVID-19, multisystem inflammatory syndrome in children, and Kawasaki disease: immunological mechanisms, clinical manifestations and management. Rheumatol Int 2020; 41:19-32. [PMID: 33219837 PMCID: PMC7680080 DOI: 10.1007/s00296-020-04749-4] [Citation(s) in RCA: 184] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023]
Abstract
Multisystem inflammatory syndrome (MIS-C) is a pediatric hyperinflammation disorder caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). It has now been reported from several countries the world over. Some of the clinical manifestations of MIS-C mimic Kawasaki disease (KD) shock syndrome. MIS-C develops 4–6 weeks following SARS-CoV-2 infection, and is presumably initiated by adaptive immune response. Though it has multisystem involvement, it is the cardiovascular manifestations that are most prominent. High titres of anti-SARS-CoV-2 antibodies are seen in these patients. As this is a new disease entity, its immunopathogenesis is not fully elucidated. Whether it has some overlap with KD is still unclear. Current treatment guidelines recommend use of intravenous immunoglobulin and high-dose corticosteroids as first-line treatment. Mortality rates of MIS-C are lower compared to adult forms of severe COVID-19 disease.
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Kong WX, Ma FY, Fu SL, Wang W, Xie CH, Zhang YY, Gong FQ. Biomarkers of intravenous immunoglobulin resistance and coronary artery lesions in Kawasaki disease. World J Pediatr 2019; 15:168-175. [PMID: 30809758 DOI: 10.1007/s12519-019-00234-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/31/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Currently, there are no reliable indicators for predicting intravenous immunoglobulin resistance and coronary artery lesions in the early stage of Kawasaki disease. METHODS A total of 300 patients with Kawasaki disease were studied retrospectively. Laboratory data were compared between the intravenous immunoglobulin resistant (29 patients) and responsive groups, and between the groups with coronary artery lesions (48 patients) and without coronary artery lesions. RESULTS The intravenous immunoglobulin resistant group had significantly higher D-dimer, globulin, interleukin-6 and serum ferritin levels in comparison to the intravenous immunoglobulin responder group. D-dimer level had a sensitivity of 87.0% and a specificity of 56.3% for predicting intravenous immunoglobulin resistance at a cutoff point of 1.09 mg/L. Globulin had a sensitivity of 62.1% and a specificity of 82.3% for predicting intravenous immunoglobulin resistance at a cutoff point of 34.7 g/L. Serum ferritin level had a sensitivity of 42.9% and a specificity of 88.8% for predicting intravenous immunoglobulin resistance at a cutoff point of 269.7 ng/mL. The patients with coronary artery lesions had higher D-dimer and tumor necrosis factor-α level. D-dimer level had a sensitivity of 50% and a specificity of 78.6% for predicting coronary artery lesions at a cutoff point of 1.84 mg/L. Based on analysis by multivariate logistic regression, serum ferritin and globulin were independent risks for intravenous immunoglobulin resistance, D-dimer was independent risk for coronary artery lesions. CONCLUSIONS Elevated serum ferritin, globulin and D-dimer levels are significantly associated with intravenous immunoglobulin resistance in Kawasaki disease. Moreover, serum D-dimer is significantly increased in Kawasaki disease with coronary artery lesions.
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Affiliation(s)
- Wei-Xing Kong
- Department of Cardiovascular Diseases, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Hangzhou 310052, China
| | - Fei-Yue Ma
- Department of Cardiovascular Diseases, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Hangzhou 310052, China
| | - Song-Ling Fu
- Department of Cardiovascular Diseases, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Hangzhou 310052, China
| | - Wei Wang
- Department of Cardiovascular Diseases, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Hangzhou 310052, China
| | - Chun-Hong Xie
- Department of Cardiovascular Diseases, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Hangzhou 310052, China
| | - Yi-Ying Zhang
- Department of Cardiovascular Diseases, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Hangzhou 310052, China
| | - Fang-Qi Gong
- Department of Cardiovascular Diseases, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Hangzhou 310052, China.
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Altammar F, Lang B. Kawasaki Disease in the neonate: case report and literature review. Pediatr Rheumatol Online J 2018; 16:43. [PMID: 29970110 PMCID: PMC6029347 DOI: 10.1186/s12969-018-0263-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 06/20/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Kawasaki Disease (KD), the leading cause of acquired heart disease in children in the developed world, is extremely rare in neonates. We present a case of incomplete KD in a neonate and a review of the literature on neonatal KD. CASE PRESENTATION A previously healthy full term 15 day old Caucasian male with an unremarkable antenatal and perinatal history, presented on Day 2 of illness with fever, rash, irritability, and poor feeding. Examination revealed fever (39.6C), tachycardia, tachypnea, extreme irritability, and a generalized maculopapular rash, but was otherwise normal. His complete blood count, CRP and ESR were normal. Empiric intravenous antibiotics and acyclovir resulted in no improvement. On day 4, he had ongoing fever and developed recurrent apnea, required supplemental oxygen, and was transferred to the pediatric intensive care unit. On day 6, he developed bilateral non-purulent conjunctivitis, palmar erythema, bilateral non-pitting edema and erythema of his feet, and arthritis. His full septic work-up and viral studies were negative. On Day 7 he was treated with intravenous immunoglobulin, and over the next 48 h his symptoms including extremity edema resolved, he no longer required supplemental oxygen, and fever did not recur. On day 9 of illness he had marked thrombocytosis. Subsequently, he developed distal extremity desquamation. Repeated echocardiograms excluded the presence of coronary artery aneurysms (CAA). CONCLUSIONS We believe this to be a rare case of incomplete KD in a neonate, in which timely IVIG administration led to resolution of the acute illness and may have prevented CAA. A comprehensive English-language medical literature review of KD presenting in the neonatal period revealed only fifteen case reports. Cases often presented with incomplete KD, and a number had atypical laboratory features including a normal CRP in the acute phase, similar to what was seen in our patient. This case and our literature review should increase awareness that KD can rarely occur in neonates, often presenting atypically. Recognizing KD in a neonate enables appropriate treatment that can result in resolution of symptoms and may decrease the risk of cardiac complications.
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Affiliation(s)
- Fajer Altammar
- 0000 0004 1936 8200grid.55602.34Department of Pediatrics, IWK Health Centre, Dalhousie University, 5980 University Ave, Halifax, NS B3K 6R8 Canada
| | - Bianca Lang
- Division of Rheumatology, Department of Pediatrics, IWK Health Centre, Dalhousie University, 5980 University Ave, Halifax, NS, B3K 6R8, Canada.
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García-Pavón S, Yamazaki-Nakashimada MA, Báez M, Borjas-Aguilar KL, Murata C. Kawasaki Disease Complicated With Macrophage Activation Syndrome: A Systematic Review. J Pediatr Hematol Oncol 2017; 39:445-451. [PMID: 28562511 DOI: 10.1097/mph.0000000000000872] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Macrophage activation syndrome (MAS), also known as secondary hemophagocytic lymphohistiocytosis, is a rare and potentially fatal complication of Kawasaki disease (KD). We report 2 cases, performed a literature search, and analyze the characteristics of MAS associated with KD. A total of 69 patients were evaluated, 34 reported the date of the diagnosis of MAS and KD, 6% had a diagnosis of MAS before KD, 21% had a simultaneous presentation, and 73% had the diagnosis of MAS after KD. Different treatment approaches were observed with corticosteroids administered in 87%, cyclosporine in 49%, etoposide (VP-16) in 39%, and monoclonal anti-TNF in 6% of cases. Coronary abnormalities were especially high in this group of patients (46%) and 9 patients died (13%). The persistence of fever with splenomegaly, hyperferritinemia, thrombocytopenia, and elevated aspartate aminotransferase (AST) should prompt the consideration of MAS complicating KD.
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Affiliation(s)
- Susana García-Pavón
- *Allergy and Immunology Department, Naval Hospital of High Speciality †Clinical Immunology Department, National Institute of Pediatrics ‡Pediatric Private Practice §Research Methodology Department, National Institute of Pediatrics
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Yamamoto N, Sato K, Hoshina T, Kojiro M, Kusuhara K. Utility of ferritin as a predictor of the patients with Kawasaki disease refractory to intravenous immunoglobulin therapy. Mod Rheumatol 2015; 25:898-902. [PMID: 25849851 DOI: 10.3109/14397595.2015.1038430] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The aim of this study is to investigate whether ferritin can be a useful marker for the prediction of the patients with Kawasaki disease (KD) refractory to initial intravenous immunoglobulin (IVIG) therapy. METHODS This retrospective study enrolled 85 patients with KD hospitalized at Kitakyushu General Hospital during 2010-2014. These patients were divided into IVIG responders (n = 57) and non-responders (n = 28). Serum ferritin levels and the scoring systems for the prediction of non-responsiveness to initial IVIG therapy were compared between these two groups. RESULTS Serum ferritin level was significantly elevated in non-responders (p = 0.010). The area under the receiver-operating characteristics curve was 0.674, and the sensitivity and specificity in more than 165 ng/ml of serum ferritin level were 70.4% and 63.2%, respectively. In two of the three prediction scoring systems, non-responders also showed significantly higher scores than responders, but many non-responders had low scores of these scoring systems. More than half of the patients with a low score of these scoring systems had high serum ferritin level (≥ 165 ng/ml). CONCLUSIONS Serum ferritin level might be a useful marker for the prediction of non-responsiveness to initial IVIG therapy and could be an important complementary marker to the prediction scoring systems.
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Affiliation(s)
- Noboru Yamamoto
- a Department of Pediatrics , Kitakyushu General Hospital , Kitakyushu , Japan.,b Department of Pediatrics , School of Medicine, University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Kaoru Sato
- a Department of Pediatrics , Kitakyushu General Hospital , Kitakyushu , Japan
| | - Takayuki Hoshina
- b Department of Pediatrics , School of Medicine, University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Masumi Kojiro
- a Department of Pediatrics , Kitakyushu General Hospital , Kitakyushu , Japan
| | - Koichi Kusuhara
- b Department of Pediatrics , School of Medicine, University of Occupational and Environmental Health , Kitakyushu , Japan
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