Table 1.
Laboratory values
| Hospital Day | CRP, mg/dl (normal <10) | ESR, mm/hr (normal <15) | Hb, g/dl (normal 12.5-19) | WBC × 10 3/ mm 3 (normal 6–18) | Neutrophil (%) (normal 19–45) | PLTs × 10 3/ mm 3 (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) |
CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; Hb: hemoglobin; WBC: white blood count; PLTs: platelets; AST: aspartate aminotransferase; ALT: alanine aminotransferase; GGT: gamma-glutamyl transpeptidase; IVIG: intravenous immunoglobulin treatment.