Immune globulin
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Immune globulin Hypotension: case report
A 5-year-old boy developed hypotension during treatment with immune globulin for incomplete Kawasaki disease. The boy was admitted to the paediatric inpatient ward with fever for 8 days. He had a history of rash, conjunctivitis, swelling (palms and soles), diarrhoea, decreased appetite, abdominal pain and dysuria. Four days prior to the admission, he tested positive for streptococcal antigen and was treated with cefdinir without clinical improvement. Following examination, he was diagnosed with incomplete Kawasaki disease. Subsequently, investigations led to a diagnosis of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. He was shifted to the paediatric ICU. He received unspecified fluid boluses. Additionally, IV infusion of immune globulin [immunoglobulin; dosage not stated] was started for Kawasaki disease. However, he developed recurrent hypotension secondary to immune globulin [duration of treatment to reaction onset not stated]. The boy’s immune globulin therapy was discontinued. Thereafter, he underwent treatment with high-flow nasal cannula for increased dyspnoea and tachypnoea. Subsequently, he became haemodynamically stable and high-flow nasal cannula was weanedoff. The boy’s therapy with immune globulin infusion was re-initiated slowly at 5g over 10h with infusion rate 2–5 mL/min following premedication with various drugs. He received six infusions with a total dose of 30g (1.8 g/kg) using a different formulation. Additionally, he received aspirin for underlying Kawasaki disease. He recovered on the paediatric floor following unspecified supportive therapy for COVID-19, and after 6 days of hospitalisation, he was discharged. Rivera-Figueroa EI, et al. Incomplete Kawasaki Disease in a Child with COVID-19. Indian Pediatrics 57: 680-681, No. 7, 15 Jul 2020. Available from: URL: http:// doi.org/10.1007/s13312-020-1900-0
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Reactions 19 Sep 2020 No. 1822
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