Images in Clinical Rheumatology
Post-infectious Digital Ischemia Successfully Treated with Iloprost in a Child
Isquemia digital postinfecciosa infantil tratada con éxito con iloprost
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"etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Isquemia digital postinfecciosa infantil tratada con éxito con iloprost" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1112 "Ancho" => 1867 "Tamanyo" => 242350 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ischemic lesions at the admission (A), at the 13th (B) and at the 21st day (C) of therapy with intravenous iloprost.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report a case of a 14-month-old girl, with no relevant pathological history, which presented additive bullous lesions on her hands and feet fingertips. She had no previous burn, trauma or other associated events. One week before, she was diagnosed with Acute Otitis Media and was treated with amoxicillin/clavulanic acid for 8 days. Later on, the fingertip lesions progressively evolved into necrotic lesions and, after two months of the initial presentation, she was observed at our hospital. Objectively, she was afebrile and presented digital plaques of dry necrosis, with edema and redness of the distal end of the affected fingers, without fluctuation or drainage of any content (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Peripheral arterial pulses were symmetric and no vascular or heart bruits were audible. As iloprost has been described to be safe and effective for the treatment of ischemic digits in children, intravenous iloprost (0.4<span class="elsevierStyleHsp" style=""></span>ng/kg/min for 5 days followed by 0.6<span class="elsevierStyleHsp" style=""></span>ng/kg/min) and acetylsalicylic acid were started.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1-4</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Concerning laboratory studies, she had CRP (50<span class="elsevierStyleHsp" style=""></span>mg/L) and ESR (60<span class="elsevierStyleHsp" style=""></span>mm/1st hour) elevation; negative serologies for EBV, Herpes simplex, CMV, parvovirus and <span class="elsevierStyleItalic">Mycoplasma pneumoniae</span>; negative antistreptolysin O titer and blood cultures. Pro-thrombotic and immunological studies (complement levels, rheumatoid factor, ANA, anti-ENA, anti-dsDNA, ANCA and antiphospholipid antibodies) were unremarkable. Echocardiogram, chest and hands X-rays, and abdominal ultrasound were normal.</p><p id="par0015" class="elsevierStylePara elsevierViewall">She completed 21 days of iloprost and gradually presented resolution of the fingertip lesions. Considering the previous infection and the diagnostic work-up, we considered the digital ischemia in a probable post-infectious context.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Digital ischemia is described in meningococcal infection, which can present extrameningeal involvement in up to 19% of patients.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> Additionally, few cases were also reported with other infectious agents.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,6</span></a> Among others, treatment with antiplatelet drugs, topical nitrates and sympathetic blockade is described.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> Besides our report, favorable response to iloprost was documented in 4 children with post-infectious digital ischemia.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,4,8</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">No specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described in this manuscript.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-04-16" "fechaAceptado" => "2018-05-29" "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1112 "Ancho" => 1867 "Tamanyo" => 242350 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ischemic lesions at the admission (A), at the 13th (B) and at the 21st day (C) of therapy with intravenous iloprost.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Iloprost for the treatment of digital ischaemia in pediatric septic shock]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. 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| 2022 Noviembre | 35 | 47 | 82 |
| 2022 Octubre | 51 | 30 | 81 |
| 2022 Septiembre | 39 | 32 | 71 |
| 2022 Agosto | 37 | 78 | 115 |
| 2022 Julio | 34 | 39 | 73 |
| 2022 Junio | 28 | 38 | 66 |
| 2022 Mayo | 27 | 30 | 57 |
| 2022 Abril | 39 | 33 | 72 |
| 2022 Marzo | 38 | 38 | 76 |
| 2022 Febrero | 33 | 35 | 68 |
| 2022 Enero | 29 | 42 | 71 |
| 2021 Diciembre | 37 | 43 | 80 |
| 2021 Noviembre | 27 | 43 | 70 |
| 2021 Octubre | 86 | 49 | 135 |
| 2021 Septiembre | 46 | 43 | 89 |
| 2021 Agosto | 40 | 35 | 75 |
| 2021 Julio | 27 | 20 | 47 |
| 2021 Junio | 35 | 37 | 72 |
| 2021 Mayo | 23 | 47 | 70 |
| 2021 Abril | 47 | 80 | 127 |
| 2021 Marzo | 47 | 22 | 69 |
| 2020 Diciembre | 23 | 0 | 23 |
| 2020 Septiembre | 2 | 2 | 4 |
| 2020 Agosto | 1 | 2 | 3 |
| 2020 Junio | 3 | 2 | 5 |
| 2020 Febrero | 1 | 2 | 3 |
| 2019 Mayo | 49 | 56 | 105 |
| 2019 Abril | 37 | 19 | 56 |
| 2019 Marzo | 27 | 21 | 48 |
| 2019 Febrero | 17 | 11 | 28 |
| 2019 Enero | 5 | 11 | 16 |
| 2018 Noviembre | 0 | 1 | 1 |
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