Effective therapy with infliximab for clinically mild encephalitis/encephalopathy with a reversible splenial lesion in an infant with Kawasaki disease.
Identifieur interne : 000E15 ( Main/Exploration ); précédent : 000E14; suivant : 000E16Effective therapy with infliximab for clinically mild encephalitis/encephalopathy with a reversible splenial lesion in an infant with Kawasaki disease.
Auteurs : Yoshie Kurokawa ; Hiroshi Masuda ; Tohru Kobayashi ; Hiroshi Ono ; Hitoshi Kato ; Ken-Ichi Imadome ; Jun Abe ; Yuichi Abe ; Shuichi Ito ; Akira IshiguroSource :
- Nihon Rinsho Men'eki Gakkai kaishi = Japanese journal of clinical immunology [ 1349-7413 ] ; 2017.
Descripteurs français
- KwdFr :
- Encéphale (imagerie diagnostique), Encéphalite (diagnostic), Encéphalite (imagerie diagnostique), Encéphalite (traitement médicamenteux), Encéphalite (étiologie), Enfant d'âge préscolaire, Femelle, Humains, Imagerie par résonance magnétique, Infliximab (administration et posologie), Maladie de Kawasaki (), Maladie de Kawasaki (diagnostic), Maladie de Kawasaki (traitement médicamenteux), Neuroimagerie, Perfusions veineuses, Résultat thérapeutique, Électroencéphalographie.
- MESH :
- administration et posologie : Infliximab.
- diagnostic : Encéphalite, Maladie de Kawasaki.
- imagerie diagnostique : Encéphale, Encéphalite.
- traitement médicamenteux : Encéphalite, Maladie de Kawasaki.
- étiologie : Encéphalite.
- Enfant d'âge préscolaire, Femelle, Humains, Imagerie par résonance magnétique, Maladie de Kawasaki, Neuroimagerie, Perfusions veineuses, Résultat thérapeutique, Électroencéphalographie.
English descriptors
- KwdEn :
- Brain (diagnostic imaging), Child, Preschool, Electroencephalography, Encephalitis (diagnosis), Encephalitis (diagnostic imaging), Encephalitis (drug therapy), Encephalitis (etiology), Female, Humans, Infliximab (administration & dosage), Infusions, Intravenous, Magnetic Resonance Imaging, Mucocutaneous Lymph Node Syndrome (complications), Mucocutaneous Lymph Node Syndrome (diagnosis), Mucocutaneous Lymph Node Syndrome (drug therapy), Neuroimaging, Treatment Outcome.
- MESH :
- chemical , administration & dosage : Infliximab.
- complications : Mucocutaneous Lymph Node Syndrome.
- diagnosis : Encephalitis, Mucocutaneous Lymph Node Syndrome.
- diagnostic imaging : Brain, Encephalitis.
- drug therapy : Encephalitis, Mucocutaneous Lymph Node Syndrome.
- etiology : Encephalitis.
- Child, Preschool, Electroencephalography, Female, Humans, Infusions, Intravenous, Magnetic Resonance Imaging, Neuroimaging, Treatment Outcome.
Abstract
Kawasaki disease (KD) is a systemic vasculitis in infants. In KD, encephalopathy is rarely (0.1%) associated, however, clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) has previously been reported in some pediatric patients. Here, we report on a 2-year-old girl who had KD complicated with MERS. The patient experienced generalized clonic convulsion and prolonged consciousness disturbance with fever for 2 days. Her head MRI showed a high signal intensity lesion in the splenium of the corpus callosum in diffusion-weighted images, and low apparent diffusion coefficient (ADC) values on day 3. An electroencephalogram showed high voltage slow waves on the occipital and parietal head. On the same day, it was confirmed that the patient showed all the main symptoms of KD. Based on these findings, we diagnosed her with MERS-complicated KD. Even though she was treated with immunoglobulin (total 4 g/kg) and pulsed-dose methylprednisolone, her fever and consciousness disturbance continued, and blood tests showed that inflammation markers remained high. We then treated the patient with infliximab on day 9, and within a few hours of the treatment her fever dropped and all symptoms of KD and consciousness disturbance disappeared. No recurrence of KD or other complications of KD occurred, and she was discharged on day 23. We propose that infliximab is an effective optional treatment for immunoglobulin/glucocorticoid-resistant KD with MERS. To clarify this possibility, further case accumulation is warranted.
DOI: 10.2177/jsci.40.190
PubMed: 28747606
Affiliations:
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imaging)</term><term>Child, Preschool</term><term>Electroencephalography</term><term>Encephalitis (diagnosis)</term><term>Encephalitis (diagnostic imaging)</term><term>Encephalitis (drug therapy)</term><term>Encephalitis (etiology)</term><term>Female</term><term>Humans</term><term>Infliximab (administration & dosage)</term><term>Infusions, Intravenous</term><term>Magnetic Resonance Imaging</term><term>Mucocutaneous Lymph Node Syndrome (complications)</term><term>Mucocutaneous Lymph Node Syndrome (diagnosis)</term><term>Mucocutaneous Lymph Node Syndrome (drug therapy)</term><term>Neuroimaging</term><term>Treatment Outcome</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Encéphale (imagerie diagnostique)</term><term>Encéphalite (diagnostic)</term><term>Encéphalite (imagerie diagnostique)</term><term>Encéphalite (traitement médicamenteux)</term><term>Encéphalite (étiologie)</term><term>Enfant d'âge préscolaire</term><term>Femelle</term><term>Humains</term><term>Imagerie par résonance magnétique</term><term>Infliximab (administration et posologie)</term><term>Maladie de Kawasaki ()</term><term>Maladie de Kawasaki (diagnostic)</term><term>Maladie de Kawasaki (traitement médicamenteux)</term><term>Neuroimagerie</term><term>Perfusions veineuses</term><term>Résultat thérapeutique</term><term>Électroencéphalographie</term></keywords><keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Infliximab</term></keywords><keywords scheme="MESH" qualifier="administration et posologie" xml:lang="fr"><term>Infliximab</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Mucocutaneous Lymph Node Syndrome</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Encephalitis</term><term>Mucocutaneous Lymph Node Syndrome</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Encéphalite</term><term>Maladie de Kawasaki</term></keywords><keywords scheme="MESH" qualifier="diagnostic imaging" xml:lang="en"><term>Brain</term><term>Encephalitis</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Encephalitis</term><term>Mucocutaneous Lymph Node Syndrome</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Encephalitis</term></keywords><keywords scheme="MESH" qualifier="imagerie diagnostique" xml:lang="fr"><term>Encéphale</term><term>Encéphalite</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Encéphalite</term><term>Maladie de Kawasaki</term></keywords><keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Encéphalite</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Child, Preschool</term><term>Electroencephalography</term><term>Female</term><term>Humans</term><term>Infusions, Intravenous</term><term>Magnetic Resonance Imaging</term><term>Neuroimaging</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Enfant d'âge préscolaire</term><term>Femelle</term><term>Humains</term><term>Imagerie par résonance magnétique</term><term>Maladie de Kawasaki</term><term>Neuroimagerie</term><term>Perfusions veineuses</term><term>Résultat thérapeutique</term><term>Électroencéphalographie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Kawasaki disease (KD) is a systemic vasculitis in infants. In KD, encephalopathy is rarely (0.1%) associated, however, clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) has previously been reported in some pediatric patients. Here, we report on a 2-year-old girl who had KD complicated with MERS. The patient experienced generalized clonic convulsion and prolonged consciousness disturbance with fever for 2 days. Her head MRI showed a high signal intensity lesion in the splenium of the corpus callosum in diffusion-weighted images, and low apparent diffusion coefficient (ADC) values on day 3. An electroencephalogram showed high voltage slow waves on the occipital and parietal head. On the same day, it was confirmed that the patient showed all the main symptoms of KD. Based on these findings, we diagnosed her with MERS-complicated KD. Even though she was treated with immunoglobulin (total 4 g/kg) and pulsed-dose methylprednisolone, her fever and consciousness disturbance continued, and blood tests showed that inflammation markers remained high. We then treated the patient with infliximab on day 9, and within a few hours of the treatment her fever dropped and all symptoms of KD and consciousness disturbance disappeared. No recurrence of KD or other complications of KD occurred, and she was discharged on day 23. We propose that infliximab is an effective optional treatment for immunoglobulin/glucocorticoid-resistant KD with MERS. To clarify this possibility, further case accumulation is warranted.</div></front></TEI><affiliations><list></list><tree><noCountry><name sortKey="Abe, Jun" sort="Abe, Jun" uniqKey="Abe J" first="Jun" last="Abe">Jun Abe</name><name sortKey="Abe, Yuichi" sort="Abe, Yuichi" uniqKey="Abe Y" first="Yuichi" last="Abe">Yuichi Abe</name><name sortKey="Imadome, Ken Ichi" sort="Imadome, Ken Ichi" uniqKey="Imadome K" first="Ken-Ichi" last="Imadome">Ken-Ichi Imadome</name><name sortKey="Ishiguro, Akira" sort="Ishiguro, Akira" uniqKey="Ishiguro A" first="Akira" last="Ishiguro">Akira Ishiguro</name><name sortKey="Ito, Shuichi" sort="Ito, Shuichi" uniqKey="Ito S" first="Shuichi" last="Ito">Shuichi Ito</name><name sortKey="Kato, Hitoshi" sort="Kato, Hitoshi" uniqKey="Kato H" first="Hitoshi" last="Kato">Hitoshi Kato</name><name sortKey="Kobayashi, Tohru" sort="Kobayashi, Tohru" uniqKey="Kobayashi T" first="Tohru" last="Kobayashi">Tohru Kobayashi</name><name sortKey="Kurokawa, Yoshie" sort="Kurokawa, Yoshie" uniqKey="Kurokawa Y" first="Yoshie" last="Kurokawa">Yoshie Kurokawa</name><name sortKey="Masuda, Hiroshi" sort="Masuda, Hiroshi" uniqKey="Masuda H" first="Hiroshi" last="Masuda">Hiroshi Masuda</name><name sortKey="Ono, Hiroshi" sort="Ono, Hiroshi" uniqKey="Ono H" first="Hiroshi" last="Ono">Hiroshi Ono</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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