RESUMO
OBJECTIVE: To investigate the safety, tolerability, and pharmacokinetics of the anti-tumor necrosis factor-alpha monoclonal antibody infliximab in subjects with intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD). STUDY DESIGN: We conducted a multicenter, randomized, prospective trial of second IVIG infusion (2 g/kg) versus infliximab (5 mg/kg) in 24 children with acute KD and fever after initial treatment with IVIG. Primary outcome measures were the safety, tolerability, and pharmacokinetics of infliximab. Secondary outcome measures were duration of fever and changes in markers of inflammation. RESULTS: Study drug infusions were associated with cessation of fever within 24 hours in 11 of 12 subjects treated with infliximab and in 8 of 12 subjects retreated with IVIG. No infusion reactions or serious adverse events were attributed to either study drug. No significant differences were observed between treatment groups in the change from baseline for laboratory variables, fever, or echocardiographic assessment of coronary arteries. CONCLUSIONS: Both infliximab and a second IVIG infusion were safe and well tolerated in the subjects with KD who were resistant to standard IVIG treatment. The optimal management of patients resistant to IVIG remains to be determined.
Assuntos
Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Imunoglobulinas Intravenosas/uso terapêutico , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Anti-Inflamatórios/efeitos adversos , Anti-Inflamatórios/farmacocinética , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/farmacocinética , Área Sob a Curva , Criança , Pré-Escolar , Aneurisma Coronário/diagnóstico por imagem , Estudos Cross-Over , Resistência a Medicamentos , Feminino , Febre/tratamento farmacológico , Meia-Vida , Humanos , Imunoglobulinas Intravenosas/efeitos adversos , Imunoglobulinas Intravenosas/sangue , Lactente , Infliximab , Infusões Intravenosas , Masculino , Taxa de Depuração Metabólica , UltrassonografiaAssuntos
Colite/diagnóstico , Doença de Crohn/diagnóstico , Tuberculose Gastrointestinal/diagnóstico , Dor Abdominal/etiologia , Adolescente , Anastomose Cirúrgica , Anti-Infecciosos/administração & dosagem , Antituberculosos/administração & dosagem , Apendicectomia , Ciprofloxacina/administração & dosagem , Colectomia , Colite/complicações , Colite/cirurgia , Diagnóstico Diferencial , Emigrantes e Imigrantes , Seguimentos , Infecções por Helicobacter/complicações , Infecções por Helicobacter/diagnóstico , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , México/etnologia , Radiografia Abdominal , Tomografia Computadorizada por Raios X , Tuberculose Gastrointestinal/complicações , Tuberculose Gastrointestinal/tratamento farmacológico , Estados Unidos , Vômito/etiologiaRESUMO
OBJECTIVES: To describe the clinical characteristics and course of children with laboratory-diagnosed Rocky Mountain spotted fever (RMSF) and to identify clinical findings independently associated with adverse outcomes of death or discharge with neurologic deficits. STUDY DESIGN: Retrospective chart review of 92 patients at six institutions in the southeastern and southcentral United States from 1990 to 2002. Statistical analyses used descriptive statistics and multiple logistic regression. RESULTS: Children with RMSF presented to study institutions after a median of 6 days of symptoms, which most commonly included fever (98%), rash (97%), nausea and/or vomiting (73%), and headache (61%); no other symptom or sign was present in >50% of children. Only 49% reported antecedent tick bites. Platelet counts were <150,000/mm3 in 59% of children, and serum sodium concentrations were <135 mEq/dL in 52%. Although 86% sought medical care before admission, only 4 patients received anti-rickettsial therapy during this time. Three patients died, and 13 survivors had neurologic deficits at discharge. Coma and need for inotropic support and intravenous fluid boluses were independently associated with adverse outcomes. CONCLUSIONS: Children with RMSF generally present with fever and rash. Delays in diagnosis and initiation of appropriate therapy are unacceptably common. Prognosis is guarded in those with hemodynamic instability or neurologic compromise at initiation of therapy.
Assuntos
Rickettsia rickettsii/isolamento & purificação , Febre Maculosa das Montanhas Rochosas/diagnóstico , Febre Maculosa das Montanhas Rochosas/epidemiologia , Distribuição por Idade , Análise Química do Sangue , Criança , Pré-Escolar , Intervalos de Confiança , Feminino , Seguimentos , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Razão de Chances , Medição de Risco , Febre Maculosa das Montanhas Rochosas/fisiopatologia , Índice de Gravidade de Doença , Distribuição por Sexo , Taxa de Sobrevida , Estados Unidos/epidemiologiaRESUMO
We report a case of chronic recurrent clavicular osteomyelitis in association with Crohn disease. Steroid therapy resulted in partial remission; however, intractable shoulder pain and an enlarging clavicular mass subsequently recurred. Infliximab therapy resulted in significant improvement in the degree of bone pain and resolution of the large sclerotic clavicular lesion.