Table 1.
Peripheral gangrene in children with Kawasaki disease.
| Reference number | Study year | Age (month) | Sex | KD criteria | KD criteria count (out of 6) | Complete/incomplete KD | Gangrene | IVIG start day | Coronary involvement | Specific treatment of gangrene | Condition of peripheral extremity |
|---|---|---|---|---|---|---|---|---|---|---|---|
| [1] | 2015 | 4 | M | Prolonged fever | 1 | Incomplete | Peripheral gangrene on both sides lower and right-side upper extremities | ?∗ | + | Methylprednisolone pulse therapy, heparin, and cyclophosphamide | Autoamputation in distal phalanxes of the right hand and left foot |
| 2015 | 6 | F | Prolonged fever and desquamation | 2 | Incomplete | Gangrene of the middle phalanx of the right hand and finger 3 | ? | + | Methylprednisolone | No significant sequelae | |
| 2015 | 12 | M | Prolonged fever, desquamation, strawberry tongue, and LAP | 4 | Incomplete | Gangrene in distal phalanx of extremities | ? | − | Methylprednisolone, azathioprine, heparin, and infliximab | No significant sequelae | |
| [10] | 2005 | 22 y/o | M | Prolonged fever, conjunctivitis, rash, LAP, and desquamation | 5 | Complete | Peripheral gangrene of the lower limbs | Day 55 | + | Heparin, prostacyclin analogue, and prednisone | Amputation of both feet |
| [11] | 2017 | 4 y/o | M | Prolonged fever | 1 | Incomplete | Gangrene of left side of the lower lip and left index finger | ? | − | Heparin | ? |
| [12] | 2007 | 2 | M | Prolonged fever, rash, and conjunctivitis | 3 | Incomplete | Left foot | Day 8 | + | Heparin, topical TNG, methylprednisolone pulse, and infliximab | No significant sequelae |
| [13] | 2006 | 1 | M | Prolonged fever, conjunctivitis, rash, and cracked lips | 4 | Incomplete | Cyanosis of both the hands and feet | Day 14 | + | Heparin, antithrombin III supplementation, topical TNG, methylprednisolone, dipyridamole, and abciximab | Right below-knee amputation and a left forefoot amputation and autoamputation of the left third finger tip |
| [14] | 2018 | 14 | M | Prolonged fever and erythematous pharynx | 2 | Incomplete | Right index and third finger | Day 9 | + | PGE1 fresh frozen plasma methylprednisolone | Autoamputation of the second and third right fingers |
| [15] | 1991 | 2 | F | Prolonged fever, conjunctivitis, rash, and peripheral edema | 4 | Incomplete | Cyanosis of the both hands | Day 7 | + | Heparin, TPA, urokinase, PGE1, and topical TNG | Autoamputation in the distal left fourth and fifth fingers |
| 1991 | 2 | M | Prolonged fever and rash | 2 | Incomplete | Distal phalanx of the the left third finger | Day 18 | + | Heparin | Autoamputation in the distal phalanx of the left third finger | |
| 1991 | 3 | F | Prolonged fever, conjunctivitis, LAP, cracked lips, and desquamation | 5 | Complete | Right foot, left hand, and left lower leg and foot | Day 13 | + | Heparin, dipyridamole, and methylprednisolone | Autoamputation of the left hand and both legs | |
| [16] | 2001 | 3 | F | Prolonged fever | 1 | Incomplete | Gangrene of the left forehand and left forefoot | ? | + | Methylprednisolone, rTPA, and heparin | Amputation of her left hand and forefoot |
| [17] | 1988 | 5 | M | Prolonged fever, conjunctivitis, LAP, cracked lips, and rash | 5 | Complete | Both hands | − | + | Methylprednisolone, PGE1, and topical TNG | Autoamputation of the terminal phalanx of the fifth finger |
| [18] | 1995 | 2 | F | Prolonged fever, conjunctivitis, cracked lips, and rash | 4 | Incomplete | Left hand, right foot, and left foot | Day 19 | + | PGE1 heparin | No significant sequelae |
| [19] | 2011 | 4 | M | Prolonged fever, conjunctivitis, red lips, rash, and peripheral edema | 5 | Complete | Fingers and toes | Day 8 | + | Heparin IV, TNG, methylprednisolone, PGE1, and dipyridamole | Amputation of four distal phalanxes of the fingers |
| [20] | 1985 | 4 | M | Prolonged fever, rash, erythematous pharynx, palmar erythema, and desquamation | 4 | Incomplete | Cyanosis of the right hand, the digital tips of the left hand, and the toes of both feet | Day 21 | + | Heparin ganglion block | Amputation of both hands |
| [21] | 2012 | 12 | M | Prolonged fever, rash, conjunctivitis, erythematous pharynx, peripheral edema, and LAP | 6 | Complete | Gangrene of the toes and the fingers | − | − | − | Autoamputation of the tip of the right index finger |
| [22] | 2008 | 2 | M | Prolonged fever, conjunctivitis, cracked lips, rash, and peripheral edema | 5 | Complete | Distal phalanx of the fingers and toes | Day 5 | + | Methylprednisolone, MTX, heparin, and dipyridamole | No significant sequelae |
| [23] | 2007 | ? | ? | ? | Incomplete | Both feet | + | Methylprednisolone, heparin, and prostacyclin analogue | ? | ||
| [24] | 1982 | 7 | F | Prolonged fever, cracked lips, conjunctivitis, LAP, rash, and peripheral edema | 6 | Complete | Third and fourth fingertips of right hand | − | + | − | Autoamputation of the second and fifth fingers on the right hand |
| [25] | 2000 | 3 | ? | Prolonged fever | 1 | Incomplete | + | + | Methylprednisolone heparin? | ? | |
| 2000 | 5 | ? | Prolonged fever | 1 | Incomplete | + | + | ? | ? | ||
| [26] | 2019 | 10 | F | Prolonged fever, rash, conjunctivitis, peripheral edema, and strawberry tongue | 5 | Complete | Toes | Day 6 | − | Heparin topical TNG | ? |
| [27] | 2000 | 8 | M | Prolonged fever, cracked lips, conjunctivitis, LAP, rash, and peripheral edema | 6 | Complete | Both hands and feet | Day 5 | ? | Heparin dipyridamole | Amputation at the tip of the right middle finger |
| Present case | 2020 | 8 | F | Prolonged fever, rash, cracked lips, peripheral edema, and conjunctivitis | 5 | Complete | Knee | Day 20 | + | Methylprednisolone | No significant sequelae |
?∗: not provided in the article.