Department of Pediatrics, Nagoya Nishi Hospital, Nagoya, Japan.
Department of Pediatrics, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan.
Pediatr Int. 2023 Jan-Dec;65(1):e15541. doi: 10.1111/ped.15541.
Persistent low-grade fever has been observed in some patients during intravenous immunoglobulin (IVIG) therapy for Kawasaki disease (KD); however, smoldering fever (SF) has not previously been reported in patients with KD. This study aimed to clarify the clinical characteristics of SF in patients with KD.
A single-center retrospective cohort study, which included a total of 621 patients who received IVIG therapy, was conducted. Patients with a fever of 37.5-38°C lasting ≥3 days after 2 days of the initial-IVIG were defined as the SF group. Patients were divided into four groups according to the fever course: SF (n = 14), biphasic fever (BF, n = 78), non-fever after initial-IVIG (NF, n = 384), and persistent fever (PF, n = 145). The clinical features of SF were described and compared between the groups.
The median duration of fever in the SF group was 16 days, which was longer than that in any other group. The neutrophil fraction after IVIG therapy in the SF group was higher than that in the BF and NF groups but similar to that in the PF group. Repeated IVIG administration in the SF group resulted in increased IgG levels but decreased serum albumin levels. In the SF group, 29% of the patients had coronary artery lesions at 4 weeks.
The frequency of SF in KD was 2.3%. Patients with SF continued to have moderate inflammatory responses. Repeated administration of IVIG doses was not effective in treating SF, and acute coronary artery lesions were occasionally observed. Active therapeutic intervention was needed.
在川崎病（KD）患者静脉注射免疫球蛋白（IVIG）治疗期间，一些患者出现持续低度发热；然而，KD 患者的亚急性发热尚未有报道。本研究旨在阐明 KD 患者亚急性发热的临床特征。
进行了一项单中心回顾性队列研究，共纳入 621 例接受 IVIG 治疗的患者。发热 37.5-38°C，初始-IVIG 治疗 2 天后持续≥3 天的患者定义为亚急性发热（SF）组。根据发热过程将患者分为四组：SF 组（n=14）、双峰热（BF，n=78）、初始-IVIG 后无发热（NF，n=384）和持续发热（PF，n=145）。描述并比较 SF 组与其他组之间的临床特征。
SF 组发热中位数为 16 天，长于其他组。SF 组 IVIG 治疗后中性粒细胞分数高于 BF 和 NF 组，但与 PF 组相似。SF 组重复 IVIG 给药导致 IgG 水平升高而血清白蛋白水平降低。SF 组 29%的患者在 4 周时有冠状动脉病变。
KD 中 SF 的频率为 2.3%。SF 患者持续存在中度炎症反应。重复给予 IVIG 剂量对 SF 治疗无效，偶尔观察到急性冠状动脉病变。需要积极的治疗干预。
