CLIPP 11- Kawasaki

Question 1

DDX fever and rash (11)

Answer 1

• adenovirus (URI)
• Kawasaki disease
• meningococcemia (petechial rash, fever, shock/DIC)
• Measles (fever, rash on neck/mouth, unimmunized)
• RMSF (myalgias, tick exposure)
• scarlet fever (GAS, sandpaper rash)
• Stevens Johnson syndrome (erythema multiforme, stomatitis, hypersensitivity reaction)
• Enterovirus (conjunctivitis, oral ulcers, diarrhea, aseptic meningitis)
• Varicella (trunk to extremities, various stages of healing, unimmunized)
• erythema infectiosum (parvovirus B19, slapped cheek, lacy, swelling, aplastic anemia)
• Roseola (HHV6, trunk to arms and neck, follows 3-4 days high fever, <2)

Question 2

causes of unilateral cervical adenopathy (5)

Answer 2

• reactive cervical adenitis (oral process)
• Kawasaki disease
• bacterial cervical adenitis (URI hx, high fever, overlying cellulitis)
• cat scratch disease (Bartonella)
• mycobacterial infection (nontuberculous 2-4yo, well appearing)

Question 3

Kawasaki disease diagnostic criteria (7)

Answer 3

• fever at least 5 days
• changes in oral mucosa (strawberry tongue)
• extremity changes (redness/swelling)
• unilateral cervical lymphadenopathy
• rash
• conjunctivitis (bilateral, nonpurulent)
• no other apparent cause for presentation

Question 4

normal 4 year old heart rate

Answer 4

65-135bpm

Question 5

Strawberry tongue meaning on 3 causes

Answer 5

• erythematous tongue with prominent papillae

- strep pharyngitis, Kawasaki disease, TSS

Question 6

Kawasaki disease definition and time course

Answer 6

• acute inflammatory panvasculitis of unknown etiology in children
• acute phase: fever, clinical findings, serologic evidence of systemic inflammation (0-10days)
• subacute phase: most s/sx resolve, hands/feet peel, serologic inflammation (10days-3wks)
• convalescent phase:all clinical findings resolved, serologic inflammation (3-8weeks)

Question 7

Kawasaki disease complications (5)

Answer 7

• aseptic meningitis/CNS symptoms (90%)
• coronary artery aneurysm (20-25%)
• liver dysfuntion (40%)
• arthritis (30%)
• hydrops of the gallbladder (10%)

Question 8

Timing of CA aneurysm development

Answer 8

subacute phase (10days-4wks)

Question 9

Kawasaki disease treatment (4)

Answer 9

• high dose aspirin (80-100mg/kg/day) for inflammation
• IVIG (2g/kg) to reduce risk of CA aneurysm
• low dose aspirin (3-5mg/kg/day) for anti-platelet effects
• NO IBUPROFEN

Question 10

Kawasaki disease follow up care (3)

Answer 10

• cardiology
• aspirin
• influenza vaccine (reye syndrome)

Question 11

Lab evaluation of Kawasaki disease (7)

Answer 11

WBC: elevated
Hgb/Hct: normochromic, normocytic anemia
Platelets: thrombocytosis
AST/ALT: evelvated
Albumin: low
ESR/CRP: elevated
UA: sterile pyuria (urethritis)