Peripheral Gangerene, an Unusual Presentation of Infantile Kawasaki: A Case Report and Literature Review

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.

Kawasaki disease complicated by peripheral artery thrombosis: a case report and literature review

“…At the same time, we performed a right upper limb artery ultrasound examination and echocardiography, and no obvious embolism or thrombosis was found. By reviewing the relevant literature, we found that 25 patients with KD presented with complications of peripheral gangrene [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24], Therefore we believe that this peripheral thrombosis was related to KD.…”

Giant Coronary Aneurysms with Multiple Large Resistant Thromboses in an 8-Month-Old Boy with IVIg-Resistant Kawasaki Disease: A Case Report

“…This Z score uses the body surface area and the luminal diameter of the coronary artery. 3 Larger coronary artery aneurysms correlate with higher risks for clinical complications and major adverse cardiac events since blood flow changes to turbulent flow, facilitating thrombosis. 4 Depending on the classification, prophylactic anticoagulation and/or antiplatelet and intravenous immunoglobulin (IVIg) therapy can be indicated.…”

Kawasaki Disease with Peripheral and Facial Gangrene: A Case report and review of literature

“…The pathogenesis of gangrene in KD includes possible coagulopathy and vasculopathy owing to a hyper-inflammatory state that disrupts the endothelial lining. 3 Although inflammation of the coronary arteries and resultant aneurysms are the most frequent complication of KD, it is characterized by systemic inflammation involving all medium-sized arteries of the body. This process results in other atypical presentations including hepatitis, interstitial pneumonitis, gastrointestinal complaints with gallbladder hydrops, aseptic meningitis, myocarditis, pericarditis, valvulitis, pyuria, pancreatitis, and lymphadenopathy.…”