title: Kawasaki Disease and Peripheral Gangrene in Infancy.
abstract: BACKGROUND
  Early diagnosis and treatment of Kawasaki disease as the most common cause of acquired heart disease in childhood, may significantly improve the prognosis. Diagnosing infantile Kawasaki (younger than a year) is difficult because of obscure symptoms; at the same time they are at the higher risk of coronary abnormalities.
  
  
  METHODS
  We report three infants with prolonged (more than 5 days) fever and peripheral gangrene without any other clinical manifestations of Kawasaki disease. Kawasaki was diagnosed due to dilation of coronary artery and other aortic branches, thrombocytosis, and rising of ESR and CRP. All patients were treated with high dose aspirin, IVIG and pulse therapy with methylprednisolone. Additionally, cytotoxic drugs or infliximab were used for two of them because of severe aneurysms in the aortic branches. All 3 patients received aspirin with anti-platelet aggregation dose and 2 patients heparin as an anti-coagulant agent for longtime. After adequate treatment, peripheral gangrene, arterial dilations and aneurysms improved, but during 12 months follow-up coronary aneurysms did not improve completely.
  
  
  CONCLUSIONS
  Peripheral gangrene must be regarded as an important sign of infantile Kawasaki disease early treatment of which can prevent severe permanent coronary involvements and sequels.
authors.affiliation: Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Iran
authors.initials: I
authors.lastname: Malekzadeh
authors.affiliation: Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran ; Department of Pediatrics, Tehran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Vahid
authors.initials: V
authors.lastname: Ziaee
authors.affiliation: Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Taravat
authors.initials: T
authors.lastname: Sadrosadat
authors.affiliation: Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, IR Iran ; Department of Pediatrics, Tehran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Mohammad-Hassan
authors.initials: MH
authors.lastname: Moardinejad
authors.affiliation: Department of Pediatrics, Tehran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Keyhan
authors.initials: K
authors.lastname: Sayadpour-Zanjani
keywords: Gangrene; Infantile Polyarthritis; Kawasaki Disease; Vasculitis