Peripheral Gangrene Associated with Kawasaki Disease and Successful Management Using Prostacycline Analogue: A Case Report
DOI:
https://doi.org/10.1532/HSF98.20061151Abstract
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.References
Bonte I, Mahr A, Laroche L, Guillevin L, Robineau M. 2005. Peripheral gangrene in adult-onset Kawasaki disease. Scand J Rheumatol 34:71-3.nBrodmann M, Lischnig U, Friedl I, Lueger A, Pilger E, Stark G. 2000. Comparison of the effect of prostaglandine E1, prostacycline and adenosine on periphereal vascular resistance. Atherosclerosis 151:228.nBurns JC, Glode MP. 2004. Kawasaki syndrome. Lancet. 364:533-44.nChang JS, Lin JS, Peng CT, Tsai CH. 1999. Kawasaki disease complicated by peripheral gangrene. Pediatr Cardiol 20:139-42.nDogan R, Dogan OF, Yilmaz M, et al. 2004. Surgical management of infants with congenital lobar emphysema and concomitant congenital heart disease. Heart Surg Forum 7:E644-9.nKrohn C, Till H, Haraida S, et al. 2001. Multiple intestinal stenoses and peripheral gangrene: a combination of two rare surgical complications in a child with Kawasaki disease. J Pediatr Surg 36:651-3.nNewburger JW, Takahashi M, Beiser AS, et al. 1991. A single intravenous infusion of gamma globulin as compared with four infusions in the treatment of acute Kawasaki syndrome. N Engl J Med 324:1633-9.nNewburger JW, Takahashi M, Gerber MA, et al. 2004. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 110:2747-71.nTizard EJ. 2005. Complications of Kawasaki disease. Curr Pediatr 14:62-8.nTomita S, Chung K, Gidding S, Shulman ST. 1992. Peripheral gangrene associated with Kawasaki Disease. Clin Infect Dis 14:121-6.nWaldron RJ. 1993. Kawasaki disease and anaesthesia. Anesth Intens Care 21:213-7.nTrumble T, Fitch RD. 1986. Kawasaki disease—a cause of vasculitis in children. J Pediatr Orthop 6:92-5.n