Abstract 120: A Case With Left Ventricular Failure And Unconsciousness Treated With Plasma Exchange
Background: Either encephalopathy or left ventricular (LV) failure complicated with Kawasaki disease (KD) is rare but occasionally fatal. We experienced a critical case simultaneously complicated with both of them and successfully rescued by plasma exchange (PE).
Case report: A 4-year-old girl was hospitalized with a high fever lasting 7 days, conjunctival injection, reddened and swollen lips, cervical lymphadenopathy and erythema of the palms and soles. Laboratory tests revealed that her white blood cells count 35,400/μl, C-reactive protein was 35 mg/dl, N-terminal pro-brain natriuretic peptide was 15,317 pg/ml, and interleukin-6 reported afterward was 354 pg/ml. Echocardiography showed that LV ejection fraction was 40%. She was diagnosed as KD and was treated with 2g/kg of intravenous immunoglobulin (IVIG) and oral aspirin on the 7th day of illness. On the following day, however, her blood pressure declined to 80/40mmHg and LV function was becoming gradually poorer despite of intravenous injection of dobutamine. As her consciousness was unclear and electroencephalogram (EEG) indicated slow waves, she was additionally treated with D-mannitol. Infliximab is not indicated because of heart failure. Therefore, repetitive PE was started immediately after deep sedation with mechanical respiratory assist. Her fever, EEG and LV function began improving by PE consecutive 3 days, however, those findings recurrently worsened at every interval of PE. IVIG and steroid pulse therapy were added on the 12th day after PE. On the 13th day, she became defervescent and her consciousness became clear and EEG normalized. She returned to daily life without cardiac or neurologic abnormalities after discharge.
Conclusions: PE is a rapid and sufficiently effective strategy for a critical KD case when infliximab is not indicated or immediate effectiveness of steroid including pulse therapy is not expected.
Author Disclosures: Y. Abe: None. M. Ayusawa: 5. Honoraria; Modest; Teijin Pharma. M. Kato: None. A. Cho: None. H. Watanabe: None. H. Okuma: None. A. Komori: None. R. Ichikawa: None. H. Kamiyama: None. S. Takahashi: None.
- © 2015 by American Heart Association, Inc.