Intravenous immunoglobulin therapy leading to dramatic improvement in a patient with systemic juvenile idiopathic arthritis and severe pericarditis resistant to steroid pulse therapy.
A 7-year-old Japanese boy with a 4-month history of systemic juvenile idiopathic arthritis (s-JIA) experienced disease flare with spiking fever, exanthema and arthralgia. He then developed progressive dyspnea due to severe pericarditis, and proinflammatory hypercytokinemia was suspected. Methylprednisolone pulse therapy was ineffective and echocardiography showed massive pericardial effusion had persisted. Alternatively, subsequent intravenous immunoglobulin (IVIG) therapy resulted in dramatic resolution of the pericardial effusion, and his general condition significantly improved within a few days. This case report may lend further support the use of IVIG for selected patients with s-JIA and severe pericarditis.
Department of Pediatrics, Hirosaki University School of Medicine, Hirosaki 036-8562, Japan.
Tomomi
T
Aizawa-Yashiro
Eishin
E
Oki
Kazushi
K
Tsuruga
Tohru
T
Nakahata
Etsuro
E
Ito
Hiroshi
H
Tanaka
D001171:Arthritis, Juvenile / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D002648:Child; D004351:Drug Resistance; D004452:Echocardiography; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D010490:Pericardial Effusion / Q000188:drug therapy / Q000209:etiology; D010493:Pericarditis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D020551:Pulse Therapy, Drug; D012720:Severity of Illness Index
D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D008775:Methylprednisolone