Article in Japanese

Refractory Kawasaki disease complicated by convulsions, DIC, peripheral gangrene, and rupture of the chordae tendineae of the mitral valve

Junichi ISHIKAWA, Yoshiaki SHIKAMA, Kunihiko AKAGI

We describe a case of Kawasaki disease in a 2-month-old girl complicated by convulsions, DIC, peripheral gangrene, and acute heart failure due to the rupture of the chordae tendineae of the mitral valve, in which severe inflammation persisted for four weeks. This severe disease was refractory to multiple doses of intravenous immunoglobulin (IVIG), intravenous methylprednisolone, and plasmapheresis, but finally responded to an additional infusion of IVIG 27 days after the onset of fever. Mild coronary abnormalities resolved after ten months. Real-time serum levels of interleukin-6 were of great value in monitoring the effects of treatment. This article reviewed the literature relevant to Kawasaki disease complicated by peripheral gangrene or the rupture of the chordae tendineae of the mitral valve, and discussed the treatment of refractory Kawasaki disease.

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Division of Infection, Immunology and Rheumatology, Kanagawa Children's Medical Center

Key words
Received	March 29, 2011
Accepted	February 10, 2012

24 (2)：163─170,2012