Kawasaki disease: Difference between revisions
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== Background == | ==Background== | ||
*Also known as: mucocutaneous lymph node syndrome | |||
* | *[[Vasculitis]] of unknown etiology | ||
*Vasculitis of unknown etiology | |||
*Peaks at 18-24 months | *Peaks at 18-24 months | ||
**Rare in <4mo, >5yr | **Rare in <4mo, >5yr | ||
*Leading cause of acquired heart disease in children | *Leading cause of acquired heart disease in children | ||
*Coronary aneurysm more common in incomplete than in classic KD | |||
==Clinical Features== | |||
[[File:1200px-Kawasaki.png|thumb|Kawasaki disease signs]] | |||
*[[Fever]] that is high, abrupt. Anyone with a fever >5 days should get considered for a Kawasaki workup. | |||
*[[Rash]] often seen in perineum; accompanies onset of fever | |||
**Maculopapular most common; vesicles not seen | |||
*Rash often seen in perineum; accompanies onset of fever | |||
*Cardiac complications develop early on | *Cardiac complications develop early on | ||
**Coronary artery aneurysm development most prevalent as fever lessens | **Coronary artery aneurysm development most prevalent as fever lessens | ||
===Associated Symptoms=== | |||
*Cardiac | |||
**Coronary aneurysm | |||
***Most develop during 3-4th week of illness | |||
***May lead to MI (leading cause of death) | |||
**[[Myocarditis]]/[[pericarditis]] | |||
**[[Pericardial effusion]] | |||
**LV dysfunction | |||
**Valvular dysfunction | |||
**[[Dysrhythmias]] | |||
*Aseptic [[meningitis]] | |||
*[[Urethritis]] | |||
*[[Anemia]] | |||
*[[RUQ pain]], large gallbladder (hydrops on US) | |||
==Differential Diagnosis== | |||
{{Pediatric fever DDX}} | |||
{{Erythematous rash DDX}} | |||
=== | ==Evaluation== | ||
===Work-Up=== | |||
*CBC | |||
**[[Leukocytosis]] | |||
**Elevated platelets | |||
*Labs | |||
*[[LFTs]]- elevated | |||
*ESR, CRP- elevated | |||
*[[Blood culture]] | |||
*[[Urinalysis]] | |||
*[[ECG]] | |||
*[[Echocardiography|TTE]] (Coronaries, LV, valves) | |||
**Consider if f ESR≥ 40, CRP≥ 3, or if desquamation occurs | |||
*Red Top "Kawasaki Serum to CBR" | |||
===Evaluation=== | |||
*Clinical diagnosis | |||
# | {| class="wikitable" | ||
# | | align="center" style="background:#f0f0f0;"|'''Classic Kawasaki Disease''' | ||
| align="left" style="background:#f0f0f0;"|Fever for 5 days or more '''plus''' four of the following symptoms | |||
|- | |||
| ||1. Bilateral nonexudative [[conjunctivitis]] | |||
|- | |||
| ||2. Mucous membrane changes (erythema, peeling, cracking of lips, "strawberry tongue," or diffuse oropharyngeal mucosae) | |||
|- | |||
| ||3. Changes of the extremities (erythema or swelling of hands/feet, peeling of finger tips/toes in the convalescent stage) | |||
|- | |||
| ||4. [[Rash]] | |||
|- | |||
| ||5. Cervical adenopathy (more than one node >1.5 cm unusually unilateral anterior cervical) | |||
|- | |||
| '''Incomplete Kawasaki Disease'''||Fever for 5 days '''and''' two to three clinical criteria of classic Kawasaki disease '''plus''' | |||
|- | |||
| ||C-reactive protein 3.0 milligrams/L and/or erythrocyte sedimentation rate 40 mm/h '''plus''' positive echocardiogram '''or''' three or more of the following: | |||
|- | |||
| ||1. Albumin <3 grams/dL | |||
|- | |||
| ||2. [[Anemia]] | |||
|- | |||
| ||3. Elevated alanine aminotransferase (ALT) | |||
|- | |||
| ||4. Platelets >450,000/mm3 7d after fever onset | |||
|- | |||
| ||5. White blood cell count >12,000/mm3 | |||
|- | |||
| ||6. Pyuria | |||
|- | |||
|} | |||
==Management== | |||
*[[IVIG]] 2gm/kg over 12hr | |||
*[[Aspirin]] 20mg/kg/dose q6h | |||
== | ==Disposition== | ||
*Admit | |||
*Follow-up cardiac evaluation for coronary aneurysm screening | |||
==References== | |||
<References/> | |||
[[Category:Pediatrics]] | |||
Revision as of 01:05, 15 September 2019
Background
- Also known as: mucocutaneous lymph node syndrome
- Vasculitis of unknown etiology
- Peaks at 18-24 months
- Rare in <4mo, >5yr
- Leading cause of acquired heart disease in children
- Coronary aneurysm more common in incomplete than in classic KD
Clinical Features
- Fever that is high, abrupt. Anyone with a fever >5 days should get considered for a Kawasaki workup.
- Rash often seen in perineum; accompanies onset of fever
- Maculopapular most common; vesicles not seen
- Cardiac complications develop early on
- Coronary artery aneurysm development most prevalent as fever lessens
Associated Symptoms
- Cardiac
- Coronary aneurysm
- Most develop during 3-4th week of illness
- May lead to MI (leading cause of death)
- Myocarditis/pericarditis
- Pericardial effusion
- LV dysfunction
- Valvular dysfunction
- Dysrhythmias
- Coronary aneurysm
- Aseptic meningitis
- Urethritis
- Anemia
- RUQ pain, large gallbladder (hydrops on US)
Differential Diagnosis
Pediatric fever
- Upper respiratory infection (URI)
- UTI
- Sepsis
- Meningitis
- Febrile seizure
- Pneumonia
- Acute otitis media
- Whooping cough
- Unclear source
- Kawasaki disease
- Neonatal HSV
- Specific virus
Erythematous rash
- Positive Nikolsky’s sign
- Febrile
- Staphylococcal scalded skin syndrome (children)
- Toxic epidermal necrolysis/SJS (adults)
- Afebrile
- Febrile
- Negative Nikolsky’s sign
- Febrile
- Afebrile
Evaluation
Work-Up
- CBC
- Leukocytosis
- Elevated platelets
- Labs
- LFTs- elevated
- ESR, CRP- elevated
- Blood culture
- Urinalysis
- ECG
- TTE (Coronaries, LV, valves)
- Consider if f ESR≥ 40, CRP≥ 3, or if desquamation occurs
- Red Top "Kawasaki Serum to CBR"
Evaluation
- Clinical diagnosis
| Classic Kawasaki Disease | Fever for 5 days or more plus four of the following symptoms |
| 1. Bilateral nonexudative conjunctivitis | |
| 2. Mucous membrane changes (erythema, peeling, cracking of lips, "strawberry tongue," or diffuse oropharyngeal mucosae) | |
| 3. Changes of the extremities (erythema or swelling of hands/feet, peeling of finger tips/toes in the convalescent stage) | |
| 4. Rash | |
| 5. Cervical adenopathy (more than one node >1.5 cm unusually unilateral anterior cervical) | |
| Incomplete Kawasaki Disease | Fever for 5 days and two to three clinical criteria of classic Kawasaki disease plus |
| C-reactive protein 3.0 milligrams/L and/or erythrocyte sedimentation rate 40 mm/h plus positive echocardiogram or three or more of the following: | |
| 1. Albumin <3 grams/dL | |
| 2. Anemia | |
| 3. Elevated alanine aminotransferase (ALT) | |
| 4. Platelets >450,000/mm3 7d after fever onset | |
| 5. White blood cell count >12,000/mm3 | |
| 6. Pyuria |
Management
Disposition
- Admit
- Follow-up cardiac evaluation for coronary aneurysm screening