title: An elevated value on drug-induced lymphocyte stimulation test for immunoglobulin is an immunological abnormality of Kawasaki disease.
abstract: BACKGROUND
  Kawasaki disease (KD) is an acute febrile vasculitis in childhood. Currently, treatment with 2 g/kg of intravenous immunoglobulin (IVIG) is recommended. Previously we had encountered a patient with KD who showed persistent fever and a severe eruption after IVIG treatment. Using a drug-induced lymphocyte stimulation test (DLST), he was positive for an immunoglobulin product. The aim of this study was to clarify the importance of a positive value for the DLST for immunoglobulin products in KD patients.
  
  
  METHODS
  Subjects were 30 confirmed KD patients treated with IVIG at the Kagoshima Medical Association Hospital. DLST values were compared between patients with additional events and those without additional events using the stimulation index (SI = value of (3)H-thymidine absorption with antigen/without antigen). Additional events were defined as symptoms observed after IVIG that were considered unexplainable by the symptoms of KD alone.
  
  
  RESULTS
  DLST results were evaluated in 13 patients with additional events and 17 patients without additional events. Elevated DLST values were observed not only in patients with additional events but also in those without additional events. Elevated SI values were observed in the initial 14 days after IVIG and the SI values in this period were significantly higher than those after day 14 (initial 14 days, n = 20, 194 +/- 112%; after day 14, n = 10, 117 +/- 66%, p = 0.010).
  
  
  CONCLUSIONS
  Elevated SI values of DLST for immunoglobulin products are not related with additional events. Our results show they may represent one of the immunological abnormalities of KD.
authors.affiliation: Division of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, Japan. uichi@m2.kufm.kagoshima-u.ac.jp
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Nomura
authors.forename: Kiminori
authors.initials: K
authors.lastname: Masuda
authors.forename: Taisuke
authors.initials: T
authors.lastname: Eguchi
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Morita
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ueno
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Kawano
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage; D006801:Humans; D007136:Immunoglobulins / Q000032:analysis*; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007223:Infant; D008213:Lymphocyte Activation / Q000187:drug effects* / Q000276:immunology; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000276:immunology* / Q000503:physiopathology* / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous; D001241:Aspirin