Case 11 Flashcards
What are key history findings for a patient with Kawasaki disease?
Persistent fever, irritability, rash, conjunctivitis, refusal to walk.
What are key physical exam findings for a patient with Kawasaki disease?
Maculopapular rash, Nonpurulent conjunctivitis, Mucosal changes, Unilateral cervical adenopathy, Swelling in extremities.
What is on the differential for Kawasaki disease?
Stevens-Johnson Syndrome, Juvenile rheumatoid arthritis, Measles, Kawasaki disease, Rocky Mountain spotted fever, Meningococcemia, Scarlet fever, Enterovirus.
What are key lab findings for a patient with Kawasaki disease?
WBC elevated with neutrophilic predominance. Hemoglobin/hematocrit and red blood cell smear: Normochromic, normocytic anemia. Mean corpuscular volume: Normal. Platelets: Normal.
Enterovirus exanthem:
Rash usually erythematous and maculopapular and may involve the palms and soles. In hand-foot-and-mouth disease (caused by Coxsackievirus), there is a vesicular rash on hands and feet, with ulcers in the mouth.
Measles exanthem:
Initial rash appears on buccal mucosa as red lesions with central bluish white spots (Koplik spots). After prodromal fever (over 101 F), cough, coryza, and conjunctivitis, a maculopapular rash starts on neck, behind ears, and along hairline. Rash spreads downward and reaches feet in two to three days.
Erythema infectiosum (fifth disease) exanthem:
This is caused by parvovirus B19. Frequently a low-grade fever with rash appearing 7 to 10 days later. Rash starts as facial erythema - the “slapped cheek” appearance, then spreads to the trunk and has an erythematous macular appearance. The rash often lasts longest on the extremities, where it has a lacy, reticular appearance.
Meningococcemia (Neisseria meningitides) exanthem:
Abrupt onset of rash, with fever, chills, malaise, and prostration. Initial rash may be urticarial, maculopapular or petechial (marked by small, purplish hemorrhagic spots). In fulminant cases, can become purpuric, with large hemorrhages into skin.
Roseola exanthem:
Macular or maculopapular rash starts on trunk and spreads to arms and neck. Rash preceded by three to four days of high fevers, which end as rash appears. Usually in patents under two years of age.
Scarlet fever exanthem:
Very fine erythematous, blanching papular rash, often described as sandpaper-like. Starts in the groin, axillae and neck but spreads rapidly. The fever can be high, and the disease is usually self-limited, lasting less than 10 days. Etiologic agent is Group A streptococcus. Important to treat this to prevent nonsuppurative complications of strep, including rheumatic fever.
Varicella exanthem:
Rash starts on trunk and spreads to extremities and head. Each lesion progresses from erythematous macule to papule to vesicle to pustule, and then crusts over. Lesions at various stages of development. Self-limited disease lasting approximately one week.
Diffuse adenopathy:
Can be seen with infectious mononucleosis (EBV or CMV), HIV, histoplasmosis, toxoplasmosis, lymphomas, leukemia, histiocytosis, metastatic neuroblastoma, and rhabdomyosarcoma. Measles also presents with markedly generalized lymphadenopathy and splenomegaly that may last several weeks.
Cervical adenopathy:
Cervical adenopathy is common in children. However, unilateral cervical adenopathy is significant. Possible causes include:
- Bacterial cervical adenines (most commonly due to Staph aureus and strep pyogenes)
- Cat scratch disease (bartonella henselae infection) axillae most commonly involved, but also cervical, submandibular and inguinal regions.
- Reactive node from pharyngeal infection
- Kawasaki disease
- Mycobacterial infection (tuberculosis is most common cause in children over 12 years)
Palmar rash:
Rocky Mountain spotted fever, Kawasaki disease, Syphilis
Strawberry tongue:
Erythematous tongue with prominent papillae, characteristic finding of both streptococcal pharyngitis and Kawasaki disease.