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Atypical Kawasaki disease with peripheral gangrene and myocardial infarction: Therapeutic implications

  • Infectious Diseases
  • Original Paper
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Abstract

We describe a 2-month-old girl with atypical Kawasaki disease (KD) complicated by peripheral gangrene and myocardial infarction. Peripheral ischaemia leading to gangrene is a rare but serious complication of KD in infants younger than 7 months of age. Treatment has been targeted at reducing arterial inflammation, arteriospasm and thrombosis. We report the first patient with incomplete KD and peripheral ischaemia in whom therapy with prostaglandin E1 (PGE1) as vasodilating and antithrombotic agent appeared successful, restoring hand and foot perfusion without significant long-term sequelae. However, PGE1 could have supported development of myocardial infarction by shunting blood away from ischaemic areas distal to a giant coronary artery aneurysm with beginning thrombosis.

Conclusion

Atypical KD with peripheral gangrene appears to react favourably to treatment with PGE1, but needs careful monitoring to detect early signs of cardiac ischaemia.

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Abbreviations

IVGG :

intravenous gammaglobulin

KD :

Kawasaki disease

LAD :

left anterior descending

PGE1 :

prostaglandin E1

WBC :

white blood cells

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Authors and Affiliations

  1. Division of Immunology/Haematology, University Children's Hospital Zürich, Steinwiesstrasse 75, CH-8032, Zürich, Switzerland

    M. von Planta & R. A. Seger

  2. Division of Cardiology, University Children's Hospital, Zürich, Switzerland

    M. Fasnacht

  3. Intensive Care Unit, University Children's Hospital, Zürich, Switzerland

    C. Holm & S. Fanconi

Authors
  1. M. von Planta
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  2. M. Fasnacht
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  3. C. Holm
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  4. S. Fanconi
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  5. R. A. Seger
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von Planta, M., Fasnacht, M., Holm, C. et al. Atypical Kawasaki disease with peripheral gangrene and myocardial infarction: Therapeutic implications. Eur J Pediatr 154, 830–834 (1995). https://doi.org/10.1007/BF01959792

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  • DOI: https://doi.org/10.1007/BF01959792

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