以腫瘤壞死因子－甲拮抗劑(Etanercept)治療頑固性川崎氏症：一病例報告

A case of Kawasaki Disease Responding to Etanercept after Failed IVIG and Steroid Treatments

自從使用靜脈輸注免疫球蛋白治療川崎氏症以來, 冠狀動脈擴張併血管瘤的併發症已經大幅度降低。 可是有部份病人使用免疫球蛋白治療無效。 這些頑固的病例特別容易有冠狀動脈併發症。 我們報告一病例使用了兩劑免疫球蛋白及類固醇治療無效, 併發冠狀動脈擴張及血管瘤。使用腫瘤壞死因子-甲拮抗劑(etanercept)之後, 體溫很快就恢復正常, 全身性的炎症反應消失, 冠狀動脈沒有繼續惡化的情況。

Since the introduction of IVIG infusion treatment for Kawasaki disease (KD), the incidence of coronary arterial lesions (CALs) has reduced significantly. However, patients with Kawasaki disease resistant to IVIG treatment are at significant higher risk of CALs. We present a patient with KD who had persistent fever and developed CALs despite two doses IVIG treatment and methylprednisolone pulse therapy (IVMP). The patient responded to etanercept (a TNF-alpha antagonist) administration with defervescence and no further deterioration of coronary dilatation or new aneurysm formation on follow up