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Aseptic Meningitis Secondary to High-Dose Intravenous Immunoglobulin Therapy in Kawasaki Disease

Korean Journal of Pediatrics 2004;47(5):561-566.
Published online May 15, 2004.
Aseptic Meningitis Secondary to High-Dose Intravenous Immunoglobulin Therapy in Kawasaki Disease
Ae Ra Cho, Jee Yoon Park, Kyung Hyo Kim, Young Mi Hong
Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul, Korea
가와사끼병에서 고용량 면역글로불린을 투여한 후 초래되는 무균성 뇌수막염에 대한 연구
조애라, 박지윤, 김경효, 홍영미
이화대학교 의과대학 소아과학교실
Correspondence: 
Young Mi Hong, Email: hongym@chollian.net
Abstract
Purpose
: Kawasaki disease is a multisystemic inflammatory vasculitis and associated with neurologic features such as aseptic meningitis. High-dose intravenous immunoglobulin(IVIG) is used to treat Kawasaki disease and generally considered to be safe, but rare cases of aseptic meningitis with unknown etiology have been reported. The aseptic meningitis associated with Kawasaki disease was compared with meningitis as the adverse reaction of high-dose IVIG.
Methods
: Sixteen Kawasaki disease patients with typical meningeal irritation symptoms were reviewed from January 1997 to July 2002. Group I(n=11) had meningitis associated with Kawasaki disease and Group II(n=5) had meningitis as the adverse reaction of high-dose IVIG therapy. The clinical features and hematologic and cerebrospinal fluid(CSF) findings were compared between the two groups.
Results
: The duration of fever was significantly longer in group I than group II. Meningeal irritation symptoms were milder in group II than group I. Hemoglobin levels were lower in group II than group I. Monocyte counts were higher in group I than group II. In the CSF analysis, neutrophil counts were significantly higher in group II than group I. Otherwise, there were no significant differences in CSF protein and sugar levels between the two groups.
Conclusion
: Aseptic meningitis occurred in patients with Kawasaki disease after administration of high-dose IVIG. High-dose IVIG was considered to be safe in general. However, clinicians should be aware of the potential for neurologic complications such as acute aseptic meningitis in patients receiving high-dose IVIG for Kawasaki disease.
Key Words: Kawasaki disease, Intravenous immunoglobulins, Aseptic meningitis


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