Kawasaki disease
Background
- 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
- 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)
- Myo/pericarditis
- Pericardial effusion
- LV dysnfunction
- Valvular dysfunction
- Dysrhythmias
- Coronary aneurysm
- Labs
- Elevated ESR/WBC/LFTs/Plts
- Aseptic meningitis
- Urethritis
- Anemia
- RUQ pain, large GB (hydrops)
Differential Diagnosis
Diagnosis
Work-Up
- CBC
- LFTs
- ESR, CRP
- Blood Cx
- UA
- ECG
- TTE (Coronaries, LV, valves)
- Red Top "Kawasaki Serum to CBR"
Criteria
| Classic Kawasaki Disease | Incomplete Kawasaki Disease |
|---|---|
| Fever for 5 d or more plus four of the following symptoms | Fever for 5 d and two to three clinical criteria of classic Kawasaki disease |
| 1. Bilateral nonexudative conjunctivitis | plus |
| 2. Mucous membrane changes (erythema, peeling, cracking of lips, "strawberry tongue," or diffuse oropharyngeal mucosae) | C-reactive protein [[Image:]]3.0 milligrams/L and/or erythrocyte sedimentation rate [[Image:]]40 mm/h plus three or more of the following supplemental labs or positive echo |
| 3. Changes of the extremities (erythema or swelling of hands/feet, peeling of finger tips/toes in the convalescent stage) | 1. Albumin <3 grams/dL |
| 2. Anemia for age | |
| 3. Elevated alanine aminotransferase | |
| 4. Platelets >450,000/mm3 after 7 d of fever onset | |
| 4. Rash | |
| 5. Cervical adenopathy (more than one node >1.5 cm unusually unilateral anterior cervical) | 5. White blood cell count >12,000/mm3 |
| 6. Presence of pyuria |
Treatment
- IVIG 2gm/kg over 12hr
- ASA 20mg/kg/dose q6h
Disposition
- Admit