scholarly journals Autoantibodies Detected in MIS-C Patients due to Administration of Intravenous Immunoglobulin

2021 ◽  
Author(s):  
Peter D. Burbelo ◽  
Riccardo Castagnoli ◽  
Chisato Shimizu ◽  
Ottavia M. Delmonte ◽  
Kerry Dobbs ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
High Dose ◽  
Autoantibody Production ◽  
Autoantibody Profile ◽  
Insulin Dependent ◽  
Inflammatory Syndrome ◽  
High Dose Ivig ◽  
Ivig Administration

The autoantibody profile associated with known autoimmune diseases in patients with COVID-19 or multisystem inflammatory syndrome in children (MIS-C) remains poorly defined. Here we show that adults with COVID-19 had a moderate prevalence of autoantibodies against the lung antigen KCNRG, and SLE-associated Smith autoantigen. Children with COVID-19 rarely had autoantibodies; one of 59 children had GAD65 autoantibodies associated with acute insulin-dependent diabetes. While autoantibodies associated with SLE/Sjogren syndrome (Ro52, Ro60, and La) and/or autoimmune gastritis (gastric ATPase) were detected in 74% (40/54) of MIS-C patients, further analysis of these patients and of children with Kawasaki disease (KD), showed that the administration of intravenous immunoglobulin (IVIG) was largely responsible for detection of these autoantibodies in both groups of patients. Monitoring in vivo decay of the autoantibodies in MIS-C children showed that the IVIG-derived Ro52, Ro60, and La autoantibodies declined to undetectable levels by 45-60 days, but gastric ATPase autoantibodies declined more slowly requiring >100 days until undetectable. Together these findings demonstrate that administration of high-dose IVIG is responsible for the detection of several autoantibodies in MIS-C and KD. Further studies are needed to investigate autoantibody production in MIS-C patients, independently from IVIG administration.

scholarly journals Efficacy and safety associated with the infusion speed of intravenous immunoglobulin for the treatment of Kawasaki disease: a randomized controlled trial

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Saori Fukui ◽  
Mitsuru Seki ◽  
Takaomi Minami ◽  
Kazuhiko Kotani ◽  
Kensuke Oka ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Adverse Events ◽  
Intravenous Immunoglobulin ◽  
Controlled Study ◽  
Efficacy And Safety ◽  
Randomized Controlled ◽  
Link Type ◽  
Cell Counts ◽  
Infusion Speed ◽  
Ivig Administration

Abstract Background High-dose intravenous immunoglobulin (IVIG) is the mainstay of treatment for Kawasaki disease (KD). Usually, 2 g/kg of IVIG is administered over 10–24 h, depending on the institution or physician, but the association between infusion speed and effectiveness has not been reported. In this study, we evaluated the differences in efficacy and safety between two different IVIG administration speeds. Methods This was a multicenter, unblinded, randomized controlled study. Patients newly diagnosed with KD were randomized into two groups: one who received IVIG over 12 h (12H group, double speed), and one that received IVIG over 24 h (24H group, reference speed). The endpoints included the duration of fever, incidence of coronary artery abnormalities (CAAs) and of adverse events. Laboratory data were evaluated before and after IVIG administration. Results A total of 39 patients were enrolled. There was no difference between groups in fever duration after the initiation of IVIG (21 h vs. 21.5 h, p = 0.325), and no patient experienced CAAs. Two adverse events were observed in the 12H group (elevation of aspartate aminotransferase and vomiting), however no severe adverse events requiring treatments or extension of hospital stay were observed in either group. After initial IVIG administration, the change ratio of inflammatory markers, such as white blood cell counts, neutrophils, C-reactive protein, and albumin, did not show significant differences between the two groups. On the other hand, a greater increase of serum immunoglobulin G from its baseline level was observed in the 24H group compared to the 12H group (3037 ± 648 mg/dl vs. 2414 ± 248 mg/dl, p < 0.01). Conclusion The efficacy and safety of IVIG administered over 12 h (double speed) were similar to those administered over 24 h (reference speed). Trial registration University Hospital Medical Information Network (UMIN000014665). Registered 27 July 2014 – Prospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000017058

Cerebral infarction after high-dose intravenous immunoglobulin therapy for Kawasaki disease

2006 ◽  
Vol 148 (3) ◽  
pp. 399-400 ◽  
Author(s):  
Yasunori Wada ◽  
Atsushi Kamei ◽  
Yukiharu Fujii ◽  
Ken Ishikawa ◽  
Shoichi Chida
Keyword(s):  
Kawasaki Disease ◽  
Cerebral Infarction ◽  
Intravenous Immunoglobulin ◽  
Immunoglobulin Therapy ◽  
High Dose ◽  
Intravenous Immunoglobulin Therapy

scholarly journals High-dose intravenous immunoglobulin therapy induces and maintains complete remission for polyarteritis nodosa

2014 ◽  
Vol 1 (1) ◽  
pp. 13
Author(s):  
Kazu Ode ◽  
Yoshinori Taniguchi ◽  
Yoshitaka Kumon ◽  
Yoshio Terada
Keyword(s):  
Complete Remission ◽  
Intravenous Immunoglobulin ◽  
Polyarteritis Nodosa ◽  
Alternative Therapy ◽  
Ivig Therapy ◽  
Immunoglobulin Therapy ◽  
High Dose ◽  
Intravenous Immunoglobulin Therapy ◽  
First Line Therapy ◽  
High Dose Ivig

We report a case of successful high-dose intravenous immunoglobulin (IVIG) use in a patient with refractory polyarteritis nodosa (PAN). Treatments with prednisolone (PSL) and various types of immunosuppressants including methotrexate (MTX) and intravenous cyclophosphamide (IVCY) were unsuccessful, and then, high-dose IVIG therapy was added. High-dose IVIG therapy improved all symptoms including high fever, arthralgia, mononeuritis multiplex and indurated erythema due to PAN. Moreover, serum inflammatory markers were also normalized. High-dose IVIG is maintaining complete remission for PAN without flare-up for additional 4 years. Therefore, high-dose IVIG therapy might be considered as a first-line therapy in patients with PAN or alternative therapy in refractory PAN.

scholarly journals Two Cases of Kawasaki-Disease Who Showed Coronary Arterial Dilatation Even after Good Response to a Single High-dose Intravenous Immunoglobulin Infusion

2003 ◽  
Vol 53 (1) ◽  
pp. 178-178
Author(s):  
Takashi Takeuchi ◽  
Norihiro Inoue ◽  
Takaomi Minami ◽  
Shoichi Shibuta ◽  
Hiroyuki Suzuki ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
High Dose ◽  
Single High Dose

Effect of Intravenous Immunoglobulin on Prednisone Dose in Patients with Pemphigus Vulgaris

2006 ◽  
Vol 10 (5) ◽  
pp. 222-227 ◽  
Author(s):  
Nicole Mittmann ◽  
Brian Chan ◽  
Sandra Knowles ◽  
P. Régine Mydlarski ◽  
Lidia Cosentino ◽  
...  
Keyword(s):  
Intravenous Immunoglobulin ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Pemphigus Vulgaris ◽  
High Dose ◽  
Women's College ◽  
Prednisone Dose ◽  
Systemic Corticosteroids ◽  
The Mean ◽  
Ivig Administration

Background: Current therapeutic options for the treatment of pemphigus vulgaris (PV) are prednisone and immunosuppressants. Patients unresponsive to high-dose systemic corticosteroids and conventional immunosuppressants may respond to intravenous immunoglobulin (IVIG). Objective: The primary outcome was the change in prednisone dose at 6 months and 1 year post-IVIG administration. Methods: A retrospective chart review of PV patients treated at Sunnybrook and Women's College Health Sciences Centre between January 1999 and October 2004 was conducted. Demographic information, corticosteroid and IVIG use, dosage, and the timing of administration for all patients were obtained. Results: Eight PV patients, mean age of 50 years (± 14.7 years), were reviewed. There was a significant decrease in mean prednisone dose at 6 months (45%) and 12 months (71%) compared with the mean dose at the start of treatment ( p < .05). Limitations: Concomitant medication use may influence results. Conclusion: This study demonstrates that IVIG can lower prednisone doses in PV patients.

scholarly journals High-Dose Intravenous Immunoglobulin Treatment Activates Complement In Vivo

1998 ◽  
Vol 48 (3) ◽  
pp. 312-317 ◽  
Author(s):  
Mollnes ◽  
Hogasen ◽  
De Carolis ◽  
Vaquero ◽  
Nielsen ◽  
...  
Keyword(s):  
Intravenous Immunoglobulin ◽  
High Dose ◽  
Immunoglobulin Treatment

scholarly journals 474. Unique Treatment Challenges with Multisystem Inflammatory Syndrome in Children (MIS-C) compared to Kawasaki Disease Shock Syndrome

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S338-S339
Author(s):  
Rachel Downey Quick ◽  
Keren Hasbani ◽  
Donald Murphey ◽  
Mariosl Fernandez ◽  
Kenneth Shaffer ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Ivig Treatment ◽  
Medical Treatments ◽  
Cardiac Recovery ◽  
Prompt Treatment ◽  
Hospital Comparison ◽  
Inflammatory Syndrome ◽  
Ivig Administration

Abstract Background Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with Coronavirus Disease 2019 present similarly with mucocutaneous symptoms and fever. Both syndromes can progress to shock. Successful treatments for MIS-C are largely based on proven KD management. As more patients with MIS-C are treated, protocols are adjusted. Infectious Diseases (ID) specialists are often early consultants in these cases. Understanding differences in how body systems are affected in MIS-C versus KD is essential for management. Figure 1. Cardiac changes among patients with Kawasaki Disease shock syndrome (KDSS) and Muti-system Inflammatory Syndrome (MIS-C) Methods This is a single hospital comparison of 25 cases of MIS-C with mucocutaneous presentation and symptoms of shock and 25 consecutive cases of KD Shock Syndrome (KDSS). Cases were compared for demographics, symptoms, cardiac abnormalities, medical treatments, and cardiac recovery. Results Patients with MIS-C develop symptoms of shock including sustained hypotension and tachycardia at 3 times the rate of patients with KD (45% vs 13%; p&lt; 0.001). On echocardiogram, left ventricular myocardial dysfunction, assessed by ejection fraction, is more commonly noted in cases of MIS-C than KDSS (fig 1). About half of patients with MIS-C show left ventricular myocardial dysfunction initially with normalization by 6 months post-presentation in the majority (96%). Conclusion Cardiac changes and shock events related to KD and MIS-C are thought to be caused by differing inflammatory mediators. By comparing these two syndromes, we can determine ways to manage each optimally. MIS-C often results in left ventricular myocardial dysfunction, which is rarer in KD cases. Fluid resuscitation with multiple fluid boluses followed by inotropes to treat hypotension in cases of in MIS-C puts increased strain on the already weakened myocardium. Early intravenous immunoglobulin (IVIG) administration, even in the presence of mild hypotension, can simultaneously provide the patient with additional fluid and decrease the underlying inflammatory process. This prompt treatment might reduce the need for pressor support while protecting the myocardium from further damage. As early consultants in MIS-C, ID providers should be educated regarding the unique cardiac challenges of MIS-C and avoid delay in IVIG treatment and cardiologist and intensivist consultation. Disclosures All Authors: No reported disclosures

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