This patient has the typical features of Kawasaki disease: fever for >/= 5 days plus 4 of 5 of bilateral, non-purulent conjunctivitis, cervical lymphadenopathy >1.5cm, mucous membrane changes of the oral cavity: erythema, strawberry tongue, fissured lips; polymorphous (non-vesicular) rash; changes in the hands and feet (erythema of the palms and soles, edema, periungual desquamation). Kawasaki disease is an acute, self-limited vasculitis. Early treatment with IVIG and ASA within 10 days of illness significantly reduces the incidence of coronary artery aneurysms.
144
99
20
39.2
84/41
A 3 year old previously well boy presents to the emergency department with a 5 day history of fever up to 39.2oC. The child has been fully immunized. The child has some decrease in appetite but is drinking well. History of mild rhinorrhea for 1 day. No sick contacts or recent travel. On examination, the child appears irritable and responsive. On head and neck exam, bilateral conjunctival injection is noted; tympanic membranes are normal; lips and tongue appear erythematous; and there is a 2cm soft mobile non-tender cervcial lymph node on the left. There was no evidence of nuchal rigidity. Heart sounds were normal with no murmur appreciated. Peripheral pulses were normal. Chest exam was clear. Abdominal exam was unremarkable. A diffuse maculopapular rash was noted on the trunk with swelling of hands and feet. Laboratory studies are as follows:
CBC:
WBC: 8
- Absolute Neutrophil Count: 4
Hemoglobin 130
Platelets 481
Urinalysis:
WBC / HPF: 1
Partially Correct
Hamilton JL, John SP. Evaluation of Fever in Young Infants and Children. Am Fam Physician 2013: 87(4):2540260. http://www.aafp.org/afp/2013/0215/p254.html
Son MB & Newberger J. Kawasaki Disease. Pediatrics in Review 2013; 34(4): 151-162.
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Authors
Dr. Angela Punnett
angela.punnett@sickkids.ca
Dr. Jackie Lee
Jacqueline.Lee@albertahealthservices.caReviewers
Dr. Susan Bannister
Susan.Bannister@ahs.ca