From: High dose anakinra for treatment of severe neonatal Kawasaki disease: a case report
Hospital Day | CRP, mg/dl (normal <10) | ESR, mm/hr (normal <15) | Hb, g/dl (normal 12.5-19) | WBC × 103/mm3 (normal 6–18) | Neutrophil (%) (normal 19–45) | PLTs × 103/mm3 (normal 140–400) | AST, U/l (normal 15–60) | ALT, U/l (normal 10–40) | Triglyceride, mg/dl (normal <149) | Fibrinogen, mg/dl (range 220–450) | Ferritin, ng/ml (normal 50–200) | GGT, U/l (normal 8–80) | Other labs and important events related to clinical course: |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 9.6 | 14.3 | 57 | 229 | Serum sodium 130 mEq/L Total bilirubin 3.5 mg/dL | ||||||||
3 | 133.4 | 40 | 6.9 | 12.12 | 59 | 32 | 25 | 18 | 138 | Serum sodium 131 mEq/L Hypoalbuminemia of 1.8 g/dL (reference range: 3.4-5.4 g/dL) IVIG dose #1 | |||
4 | 10.1 | 16.8 | 121 | 24 | 19 | 82 | 801 | IVIG dose #2/Transfusion | |||||
6 | 191.6 | 24 | 9.9 | 27.5 | 66 | 22 | 17 | 239 | 255 | IVIG dose#3 Methylprednisolone 30 mg/kg × 3 days Flow cytometry | |||
7 | 234.1 | 113 | 8.2 | 16.6 | 52 | 273 | 207 | Anakinra started | |||||
(3 mg/kg BID) (increased to 3 mg/kg TID after 3 days) | |||||||||||||
8 | 122.9 | 64 | 7.8 | 21.5 | 133 | 16 | 14 | 213 | Slight clinical improvement | ||||
9 | 65 | 37 | 12.7 | 22.6 | 156 | 165 | Methylprednisolone (1 mg/kg BID) Marked clinical improvement Extubated day 9 Tranfusion | ||||||
12 | 98.3 | 67 | 13.2 | 19.6 | 607 | 32 | 21 | 288 | 574 | Echocardiogram: diffuse enlargement of the entire coronary artery system Infliximab 5 mg/kg ×1 Methylprednisolone increased (4 mg/kg TID) | |||
16 | 1.6 | 25 | 11.3 | 12.9 | 963 | 27 | 28 | 201 | 239 | 700 | 108 | Methylprednisolone decreased (2 mg/kg TID) | |
20 | 0.3 | 5 | 13 | 20.9 | 972 | 269 | 212 | 754 | 134 | Methylprednisolone decreased (2 mg/kg Daily) | |||
27 | <0.2 | 8 | 11.3 | 16.7 | 427 | 293 | 406 | 58 | Anakinra decreased (4 mg/kg BID) Methylprednisolone stopped Prednisolone started 1.5 mg/kg Daily (tapered over 10 days) |