A 2 yo previously healthy M presents with fever for 5 days; red, cracked lips; and general irritability.

Questions to Ask

  • Pattern of fever?
  • Associated URI symptoms?
  • Conjunctivitis?
  • Lymphadenopathy?
  • Rash?
  • Extremity changes (hand/foot swelling)?

History & Physical Exam

  • 3 days ago, PMD noted red eyes with limbic sparing.
  • This AM feet appeared puffy.
  • A macular papular rash is present over torso and extremities, sparing palms/soles.
  • On exam, he has prominent linular papillae and red, cracked lips.
  • You further note that the child is cranky and cries throughout exam.

Recommended Workup

  • Labs:
    • CBC with differential, complete metabolic panel
    • ESR, CRP
    • UA with microscopy
    • Infectious workup as appropriate (blood culture, urine culture, viral panel)
    • Antibody testing that might be needed prior to IVIg administration
  • Echocardiogram to look for coronary ectasia

Referrals

  • Admission for treatment of KD

Treatment

Key recommendations for the treatment of Kawasaki Disease from the ACR Journals, showing how to treat patients with and without clinical features of high risk for poor outcome

Reference: https://acrjournals.onlinelibrary.wiley.com/doi/10.1002/acr.24838

Related Links

Kawasaki Disease Overview

 

ACR Vasculitis Treatment Guideline

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