Korean Journal of Pediatrics 2006;49(7):784-789.
Published online July 15, 2006.
Intravenous immunoglobulin for severe gastrointestinal manifestation of Henoch-Sch nlein purpura refractory to corticosteroid therapy
Hye Ran Yang, Won Jung Choi, Jae Sung Ko, Jeong Kee Seo
Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea
스테로이드 치료에 반응하지 않는 심한 위장관 증세의 Henoch-Sch nlein 자반증 환아에서 정맥 면역글로불린 치료
양혜란, 최원정, 고재성, 서정기
서울대학교 의과대학 소아과학교실
Correspondence: 
Jeong Kee Seo, Email: jkseo@snu.ac.kr
Abstract
Purpose
: Henoch-Schönlein purpura(HSP) is a systemic vasculitis involving small vessels of skin, gastrointestinal(GI) tract and kidney. Digestive involvement of HSP can be serious with massive GI bleeding, perforation, and intussusception. However, some patients do not respond to conventional corticosteroid therapy. In this study, we investigated the efficacy of intravenous immunoglobulin (IVIG) for serious digestive manifestations not responding to steroid.
Methods
: From April 1999 to January 2005, 22 children diagnosed as HSP with severe GI symptoms were included. Initially, all patients were treated with intravenous methylprednisolone. IVIG 2 g/kg of body weight was infused in children refractory to steroid therapy. Clinical data were reviewed retrospectively.
Results
: Among 22 children, 12 children underwent IVIG therapy. The mean duration of corticosteroid therapy was 5.61¡¾4.9 days before IVIG therapy, and 11 of 12 patients experienced disappearance of GI manifestations after the initiation of IVIG infusion. In one patient, IVIG was ineffective in relieving abdominal pain, but melena subsided. Comparison of the duration of hospitalization between IVIG group and corticosteroid group revealed no significant difference(12.8¡¾7.6 days vs. 13.2¡¾7.8 days, P=0.777). But, the total duration of abdominal pain decreased in IVIG group although the difference between two groups was not significant(8.8¡¾8.1 days vs. 14.8¡¾16.9 days, P=0.306). Among 10 children treated with steroid only, 2 children were operated for bowel perforation and intussusception. In contrast, there was no perforation in 12 children who underwent IVIG therapy.
Conclusion
: IVIG could be the alternative therapy to corticosteroids in children with severe digestive manifestations of HSP.


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