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Zhang N, Yu L, Xiong Z, Hua Y, Duan H, Qiao L, Zhou K, Wang C. Kawasaki disease complicated by peripheral artery thrombosis: a case report and literature review. Pediatr Rheumatol Online J 2022; 20:77. [PMID: 36064564 PMCID: PMC9444104 DOI: 10.1186/s12969-022-00738-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/24/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Peripheral gangrene is rarely documented as a possible complication of Kawasaki disease (KD). There are many causes of peripheral gangrene, and the common cause is in situ thrombosis or embolism. Most cases are reported to have regrettable outcomes (amputation or necrotic shedding). Herein, we report the successful management of KD complicated by peripheral artery thrombosis in an older Chinese boy, and a review of all cases of peripheral gangrene in KD in the literature. CASE PRESENTATION We found that most of the children with this complication were under 1 year old, had a heavy inflammatory response combined with the use of cortisol and immunoglobulin, and most children had coronary artery lesions. In addition, Peripheral gangrene mainly occurred in the subacute or chronic stage, and the prognosis is poor. CONCLUSIONS In the presence of high risk factors, we consider it is necessary to monitor coagulation function and administer prophylactic anticoagulation therapy. When peripheral artery thrombosis or embolism occur, heparin and prostaglandins can be used for treatment.
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Affiliation(s)
- Nanjun Zhang
- grid.461863.e0000 0004 1757 9397Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China ,grid.13291.380000 0001 0807 1581West China Medical School of Sichuan University, Chengdu, Sichuan China
| | - Li Yu
- grid.461863.e0000 0004 1757 9397Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China ,grid.461863.e0000 0004 1757 9397The Cardiac Development And Early Intervention Unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China ,grid.461863.e0000 0004 1757 9397Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Department of Pediatrics, West China Second University Hospital, No. 20, Section 3, South Renmin Road, Chengdu, 610041 Sichuan China ,grid.461863.e0000 0004 1757 9397Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China
| | - Zhongxian Xiong
- Department of Pediatrics, Second People’s Hospital of Liangshan Yi Autonomous Prefecture, Xichang, Sichuan China
| | - Yimin Hua
- grid.461863.e0000 0004 1757 9397Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China ,grid.461863.e0000 0004 1757 9397The Cardiac Development And Early Intervention Unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China ,grid.461863.e0000 0004 1757 9397Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Department of Pediatrics, West China Second University Hospital, No. 20, Section 3, South Renmin Road, Chengdu, 610041 Sichuan China ,grid.461863.e0000 0004 1757 9397Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China
| | - Hongyu Duan
- grid.461863.e0000 0004 1757 9397Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China ,grid.461863.e0000 0004 1757 9397The Cardiac Development And Early Intervention Unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China ,grid.461863.e0000 0004 1757 9397Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Department of Pediatrics, West China Second University Hospital, No. 20, Section 3, South Renmin Road, Chengdu, 610041 Sichuan China ,grid.461863.e0000 0004 1757 9397Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China
| | - Lina Qiao
- grid.461863.e0000 0004 1757 9397Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Department of Pediatrics, West China Second University Hospital, No. 20, Section 3, South Renmin Road, Chengdu, 610041 Sichuan China
| | - Kaiyu Zhou
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China. .,The Cardiac Development And Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Department of Pediatrics, West China Second University Hospital, No. 20, Section 3, South Renmin Road, Chengdu, 610041, Sichuan, China. .,Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Chuan Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China. .,The Cardiac Development And Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Department of Pediatrics, West China Second University Hospital, No. 20, Section 3, South Renmin Road, Chengdu, 610041, Sichuan, China. .,Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
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López Riquelme I, Llamas Carmona JA, Godoy Díaz DJ, Gómez Moyano E, Martínez Pilar L, Vera Casaño Á. Early treatment of Kawasaki disease with peripheral ischemia: a determining factor to prevent fatal consequences. Int J Dermatol 2021; 61:e219-e220. [PMID: 34263928 DOI: 10.1111/ijd.15790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/06/2021] [Accepted: 06/29/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Irene López Riquelme
- Dermatology Department, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Daniel J Godoy Díaz
- Dermatology Department, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | | | - Ángel Vera Casaño
- Dermatology Department, Hospital Regional Universitario de Málaga, Málaga, Spain
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Tahghighi F, Bakhtiari Koohsorkhi M, Ziaee V. Peripheral Gangerene, an Unusual Presentation of Infantile Kawasaki: A Case Report and Literature Review. Case Rep Rheumatol 2021; 2021:6629405. [PMID: 33954004 PMCID: PMC8057904 DOI: 10.1155/2021/6629405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/19/2021] [Accepted: 04/03/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Diagnosing infantile Kawasaki disease with atypical symptoms is difficult, and it also has higher risk of coronary abnormalities which is one of the most common complications of KD. Other complications such as pericardial effusion, mitral insufficiency, congestive heart failure, myocardial systolic dysfunction, and systemic vasculitis were also reported. Peripheral gangrene and necrosis are among the rare complications of this systemic vasculitis. Case Presentation. We report an 8-month-old girl with prolonged fever, generalized petechial rash, cracked erythematous lips, edema, and coronary ectasia who received two doses of IVIG in another center, but short after her discharge, she started to develop a necrotic plaque on her knee. She was admitted in our hospital, and the repeat echocardiography showed sustained coronary ectasia. She received 3 doses of methylprednisolone pulse therapy and was discharged with aspirin and prednisolone. In the follow-up visits, the coronary ectasia was resolved and the necrotic ulcer was healing with a scar. CONCLUSIONS The diagnosis of Kawasaki disease and echocardiographic evaluation of the coronary arteries should be considered in young infants with prolonged fever of unknown origin. Peripheral gangrene is a rare but important complication of infantile Kawasaki disease, although the exact mechanism in not fully understood.
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Affiliation(s)
- Fatemeh Tahghighi
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Vahid Ziaee
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
- Pediatric Rheumatology Research Group, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Fundora J, Kotch C, Serwint J. A 7-month-old with Fever and Facial Palsy. Pediatr Rev 2020; 41:S30-S32. [PMID: 33004576 DOI: 10.1542/pir.2018-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Chelsea Kotch
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Janet Serwint
- Division of General Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
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Khanna G, Sargar K, Baszis KW. Pediatric vasculitis: recognizing multisystemic manifestations at body imaging. Radiographics 2016; 35:849-65. [PMID: 25969938 DOI: 10.1148/rg.2015140076] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pediatric vasculitides are multisystem diseases that can be diagnostic challenges because of variable clinical manifestations. The clinical manifestation is determined by the size of the affected vessels, organs involved, extent of vascular injury, and underlying pathologic characteristics. Henoch-Schönlein purpura and Kawasaki disease are the two most common subtypes of pediatric vasculitis. Diagnosis of pediatric vasculitis can be difficult, and the outcome can be serious or fatal in the absence of timely intervention. Imaging plays a central role in establishing the diagnosis of vasculitis involving large- and medium-sized vessels, visualizing its vascular and extravascular manifestations, and monitoring the disease course and response to treatment. Although imaging cannot depict the vessel changes of small-vessel vasculitis directly, it can be used to detect tissue damage resulting from vessel inflammation. This article discusses the classification and clinical features of the major pediatric vasculitides. The imaging approach to and nonneurologic findings of major pediatric vasculitis subtypes are reviewed for the pediatric body imager.
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Affiliation(s)
- Geetika Khanna
- From the Mallinckrodt Institute of Radiology (G.K., K.S.) and Department of Pediatrics (K.B.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131-MIR, St Louis, MO 63110
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Malekzadeh I, Ziaee V, Sadrosadat T, Moardinejad MH, Sayadpour-Zanjani K. Kawasaki Disease and Peripheral Gangrene in Infancy. IRANIAN JOURNAL OF PEDIATRICS 2015; 25:e3309. [PMID: 26635941 PMCID: PMC4662841 DOI: 10.5812/ijp.3309] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 10/13/2015] [Accepted: 10/20/2015] [Indexed: 12/19/2022]
Abstract
Introduction: Early diagnosis and treatment of Kawasaki disease as the most common cause of acquired heart disease in childhood, may significantly improve the prognosis. Diagnosing infantile Kawasaki (younger than a year) is difficult because of obscure symptoms; at the same time they are at the higher risk of coronary abnormalities. Case Presentation: We report three infants with prolonged (more than 5 days) fever and peripheral gangrene without any other clinical manifestations of Kawasaki disease. Kawasaki was diagnosed due to dilation of coronary artery and other aortic branches, thrombocytosis, and rising of ESR and CRP. All patients were treated with high dose aspirin, IVIG and pulse therapy with methylprednisolone. Additionally, cytotoxic drugs or infliximab were used for two of them because of severe aneurysms in the aortic branches. All 3 patients received aspirin with anti-platelet aggregation dose and 2 patients heparin as an anti-coagulant agent for longtime. After adequate treatment, peripheral gangrene, arterial dilations and aneurysms improved, but during 12 months follow-up coronary aneurysms did not improve completely. Conclusions: Peripheral gangrene must be regarded as an important sign of infantile Kawasaki disease early treatment of which can prevent severe permanent coronary involvements and sequels.
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Affiliation(s)
- Iran Malekzadeh
- Children’s Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Vahid Ziaee
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Vahid Ziaee, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +9821-66595522, Fax: +9821-66595525, E-mail:
| | - Taravat Sadrosadat
- Children’s Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohammad-Hassan Moardinejad
- Children’s Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, IR Iran
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, IR Iran
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Vaughan C, Graves MS, Lesher JL, White C. A Micropustular Rash in a Febrile Child. Pediatr Dermatol 2015; 32:547-8. [PMID: 26184400 DOI: 10.1111/pde.12546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Claire Vaughan
- Georgia Regents University, Medical College of Georgia, Georgia Regents University, Augusta, Georgia
| | - Michael S Graves
- Section of Dermatology, Medical College of Georgia, Georgia Regents University, Augusta, Georgia
| | - Jack L Lesher
- Section of Dermatology, Medical College of Georgia, Georgia Regents University, Augusta, Georgia
| | - Christopher White
- Department of Pediatrics, Medical College of Georgia, Georgia Regents University, Augusta, Georgia
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Kim NY, Choi DY, Jung MJ, Jeon IS. A case of refractory Kawasaki disease complicated by peripheral ischemia. Pediatr Cardiol 2008; 29:1110-4. [PMID: 18481137 DOI: 10.1007/s00246-008-9221-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 02/25/2008] [Accepted: 03/19/2008] [Indexed: 11/26/2022]
Abstract
Kawasaki disease (KD), an acute systemic vasculitis that primarily affects infants and young children, is occasionally refractory to initial high-dose intravenous immunoglobulin (IVIG). Some patients with KD develop peripheral gangrene as a fatal complication, though this is rare. There has been no case reported in the literature of complicated peripheral gangrene that completely resolved without sequelae. Recently, we encountered a patient with KD which was refractory to IVIG, later developing peripheral gangrene. For the treatment of a peripheral gangrene dexamethasone, methotrexate, and an anticoagulant were administered, resulting in resolution of the gangrenous lesions without sequelae. Early diagnosis and treatment can reduce permanent sequelae and mortality from refractory KD complicated by peripheral ischemia.
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Affiliation(s)
- Na Yeon Kim
- Department of Pediatrics, Gil Medical Center, School of Medicine, Gachon University of Medicine and Science, Incheon, Korea
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Tuncer S, Bello-Rojas G, Blake M, Jackson IT. Surgical treatment of a severe microstomia developed following leucocytoclastic vasculitis. EUROPEAN JOURNAL OF PLASTIC SURGERY 2007. [DOI: 10.1007/s00238-007-0170-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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O'connor MJ, Saulsbury FT. Incomplete and atypical Kawasaki disease in a young infant: severe, recalcitrant disease responsive to infliximab. Clin Pediatr (Phila) 2007; 46:345-8. [PMID: 17475994 DOI: 10.1177/0009922806294842] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This report describes a 7-week-old infant with incomplete and atypical Kawasaki disease, an acute vasculitis that predominantly affects infants and children. The patient was refractory to 2 doses of intravenous immunoglobulin and to high-dose intravenous methylprednisolone. He became afebrile only after 2 doses of infliximab. His prolonged, recalcitrant course was complicated by the development of peripheral gangrene and giant coronary artery aneurysms. Infants with incomplete and atypical Kawasaki disease are prone to intravenous immunoglobulin treatment failure and are at risk for the development of coronary artery aneurysms. In such patients, we suggest that consideration be given to early aggressive therapy with corticosteroids or infliximab added to intravenous immunoglobulin.
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Affiliation(s)
- Matthew J O'connor
- Department of Pediatrics, University of Virginia Health System, Charlottesville, Virginia 22908, USA
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Dogan OF, Kara A, Devrim I, Tezer H, Besbas N, Ozen S, Secmeer G, Yorgancioglu C, Boke E. Peripheral Gangrene Associated with Kawasaki Disease and Successful Management Using Prostacycline Analogue: A Case Report. Heart Surg Forum 2007; 10:E70-2. [PMID: 17311768 DOI: 10.1532/hsf98.20061151] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a case of child-onset Kawasaki disease that presented as a prolonged fever and manifested with coronary aneurysms and peripheral gangrene of the lower limbs. Therapy with intravenous immunoglobulins, corticosteroids, aspirin, anticoagulants, and ilomedine, a prostacyclin analogue, resulted in rapid improvement in the patient's condition without extremity loss. Those treating patients with Kawasaki disease must be aware of possible vascular ischemia in the disease process that is reversible by early intervention treatments, including the use of a prostacycline analogue, that improve quality of life.
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Affiliation(s)
- Omer Faruk Dogan
- Department of Cardiovascular Surgery, Hacettepe University Medical Faculty, Ankara, Turkey.
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Durall AL, Phillips JR, Weisse ME, Mullett CJ. Infantile Kawasaki disease and peripheral gangrene. J Pediatr 2006; 149:131-3. [PMID: 16860142 DOI: 10.1016/j.jpeds.2006.02.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Revised: 01/26/2006] [Accepted: 02/21/2006] [Indexed: 10/24/2022]
Abstract
We report a 1-month-old infant with Kawasaki disease and peripheral gangrene. We advocate using the newly published American Heart Association guidelines advising early laboratory and echocardiogram investigations in infants with fever but without other classic manifestations of Kawasaki disease. Initiation of early therapy may prevent this serious complication with its permanent sequelae.
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Affiliation(s)
- Amy L Durall
- Department of Anesthesia, Children's Hospital, Boston, Massachusetts, USA
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Bonté I, Mahr A, Laroche L, Guillevin L, Robineau M. Peripheral gangrene in adult-onset Kawasaki disease. Scand J Rheumatol 2005; 34:71-3. [PMID: 15903031 DOI: 10.1080/03009740410011235] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Kawasaki disease (KD) is an acute vasculitis characterized by marked tropism of the coronary vessels. Usually a childhood disease, KD can occasionally be observed in adults. We report a case of adult-onset KD that presented as a prolonged fever of unknown origin with subsequent development of severe vasculitis, manifested by coronary aneurysms and peripheral gangrene of the lower limbs. Therapy with intravenous immunoglobulins, corticosteroids, aspirin, anticoagulants, and prostacyclin analogue resulted in rapid improvement in the patient's condition but he required partial distal amputation for irreversible gangrene. Peripheral ischaemia leading to gangrene is a very rare feature of KD vasculitis with only 19 cases previously published in the Medline-indexed literature. The outcomes of those patients were poor, being either fatal or requiring distal amputation. All prior cases affected young children less than 1 year old and, to the best of our knowledge, the present case is the first description of peripheral gangrene in adult-onset KD.
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Affiliation(s)
- I Bonté
- Department of Dermatology, Avicenne Hospital, Bobigny, France
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Cura MA, Haskal ZJ, Weintraub J, Benvenisty A. SIR 2004 Film Panel Case: Systemic Artery Aneurysms in Kawasaki Disease. J Vasc Interv Radiol 2004; 15:1009-11. [PMID: 15361572 DOI: 10.1097/01.rvi.0000127895.77681.fc] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Marco A Cura
- Department of Radiology, Columbia University-New York Presbyterian Hospital, New York, NY, USA.
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Krohn C, Till H, Haraida S, Kurnik K, Boehm R, Grantzow R, Joppich I. Multiple intestinal stenoses and peripheral gangrene: a combination of two rare surgical complications in a child with Kawasaki disease. J Pediatr Surg 2001; 36:651-3. [PMID: 11283900 DOI: 10.1053/jpsu.2001.22312] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Kawasaki disease (KD) often presents with a challenging variety of clinical symptoms. Severe gastrointestinal complications are rare and mainly appear as pseudo-obstruction. However, the authors report the unique case of a 4-month-old girl with KD suffering from a mechanical ileus. The optimal timing of surgery presented a dilemma, because she received lytic treatment for gangrenes of both her hands and feet and additionally had large coronary artery aneurysms. Finally laparotomy had to be performed while the patient was on an anticoagulant medication, and it showed a 30-cm-long jejunal segment with multiple filiforme stenoses, requiring resection and anastomosis. The postoperative course was uneventful regarding the abdominal situation; however, the left hand and left foot remained gangrenous and had to be amputated. In patients with KD, not only pseudo-obstruction, but irreversible intestinal obliteration has to be encountered. This combination of intestinal stenosis and acral gangrene has not been described before. J Pediatr Surg 36:651-653.
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Affiliation(s)
- C Krohn
- Department of Pediatric Surgery, University of Munich, Lindwurmstr. 4, D-80337 Munich, Germany
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