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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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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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