Case Report

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

Table 1

Peripheral gangrene in children with Kawasaki disease.

Reference numberStudy yearAge (month)SexKD criteriaKD criteria count (out of 6)Complete/incomplete KDGangreneIVIG start dayCoronary involvementSpecific treatment of gangreneCondition of peripheral extremity

[1]20154MProlonged fever1IncompletePeripheral gangrene on both sides lower and right-side upper extremities+Methylprednisolone pulse therapy, heparin, and cyclophosphamideAutoamputation in distal phalanxes of the right hand and left foot
20156FProlonged fever and desquamation2IncompleteGangrene of the middle phalanx of the right hand and finger 3?+MethylprednisoloneNo significant sequelae
201512MProlonged fever, desquamation, strawberry tongue, and LAP4IncompleteGangrene in distal phalanx of extremities?Methylprednisolone, azathioprine, heparin, and infliximabNo significant sequelae
[10]200522 y/oMProlonged fever, conjunctivitis, rash, LAP, and desquamation5CompletePeripheral gangrene of the lower limbsDay 55+Heparin, prostacyclin analogue, and prednisoneAmputation of both feet
[11]20174 y/oMProlonged fever1IncompleteGangrene of left side of the lower lip and left index finger?Heparin?
[12]20072MProlonged fever, rash, and conjunctivitis3IncompleteLeft footDay 8+Heparin, topical TNG, methylprednisolone pulse, and infliximabNo significant sequelae
[13]20061MProlonged fever, conjunctivitis, rash, and cracked lips4IncompleteCyanosis of both the hands and feetDay 14+Heparin, antithrombin III supplementation, topical TNG, methylprednisolone, dipyridamole, and abciximabRight below-knee amputation and a left forefoot amputation and autoamputation of the left third finger tip
[14]201814MProlonged fever and erythematous pharynx2IncompleteRight index and third fingerDay 9+PGE1 fresh frozen plasma methylprednisoloneAutoamputation of the second and third right fingers
[15]19912FProlonged fever, conjunctivitis, rash, and peripheral edema4IncompleteCyanosis of the both handsDay 7+Heparin, TPA, urokinase, PGE1, and topical TNGAutoamputation in the distal left fourth and fifth fingers
19912MProlonged fever and rash2IncompleteDistal phalanx of the the left third fingerDay 18+HeparinAutoamputation in the distal phalanx of the left third finger
19913FProlonged fever, conjunctivitis, LAP, cracked lips, and desquamation5CompleteRight foot, left hand, and left lower leg and footDay 13+Heparin, dipyridamole, and methylprednisoloneAutoamputation of the left hand and both legs
[16]20013FProlonged fever1IncompleteGangrene of the left forehand and left forefoot?+Methylprednisolone, rTPA, and heparinAmputation of her left hand and forefoot
[17]19885MProlonged fever, conjunctivitis, LAP, cracked lips, and rash5CompleteBoth hands+Methylprednisolone, PGE1, and topical TNGAutoamputation of the terminal phalanx of the fifth finger
[18]19952FProlonged fever, conjunctivitis, cracked lips, and rash4IncompleteLeft hand, right foot, and left footDay 19+PGE1 heparinNo significant sequelae
[19]20114MProlonged fever, conjunctivitis, red lips, rash, and peripheral edema5CompleteFingers and toesDay 8+Heparin IV, TNG, methylprednisolone, PGE1, and dipyridamoleAmputation of four distal phalanxes of the fingers
[20]19854MProlonged fever, rash, erythematous pharynx, palmar erythema, and desquamation4IncompleteCyanosis of the right hand, the digital tips of the left hand, and the toes of both feetDay 21+Heparin ganglion blockAmputation of both hands
[21]201212MProlonged fever, rash, conjunctivitis, erythematous pharynx, peripheral edema, and LAP6CompleteGangrene of the toes and the fingersAutoamputation of the tip of the right index finger
[22]20082MProlonged fever, conjunctivitis, cracked lips, rash, and peripheral edema5CompleteDistal phalanx of the fingers and toesDay 5+Methylprednisolone, MTX, heparin, and dipyridamoleNo significant sequelae
[23]2007???IncompleteBoth feet+Methylprednisolone, heparin, and prostacyclin analogue?
[24]19827FProlonged fever, cracked lips, conjunctivitis, LAP, rash, and peripheral edema6CompleteThird and fourth fingertips of right hand+Autoamputation of the second and fifth fingers on the right hand
[25]20003?Prolonged fever1Incomplete++Methylprednisolone heparin??
20005?Prolonged fever1Incomplete++??
[26]201910FProlonged fever, rash, conjunctivitis, peripheral edema, and strawberry tongue5CompleteToesDay 6Heparin topical TNG?
[27]20008MProlonged fever, cracked lips, conjunctivitis, LAP, rash, and peripheral edema6CompleteBoth hands and feetDay 5?Heparin dipyridamoleAmputation at the tip of the right middle finger
Present case20208FProlonged fever, rash, cracked lips, peripheral edema, and conjunctivitis5CompleteKneeDay 20+MethylprednisoloneNo significant sequelae

: not provided in the article.