Kawasaki disease

Question 1

What is Kawasaki (RF, SX)

Answer 1

acute febrile self limiting systemic vasculitis of unkown origin affecting young children

often overlaps with viral infection (possible cause?)

RF: Asian, 3month -4 years, male

Sx
non-specific diffuse polymorphous rash -maculopapular 
Conjuctivitis
Cracked lips (no exudate, no ulcers, no kopliks)
Erythema and oedema in palms and soles
Enlarged cervical Lymph nodes
FEVER LASTING 5+ days (high fever)
joint pain
HALLMARK -coronary artery aneurysms

acute phase 5-11 days
then subacute 2-3weeks (this is when complications below happen)
recover after over 4-6weeks

rare but important- coronary aneurysms, pericarditis, congestive HF
hedache and stiff neck
abdo pain, diarrhoae, jaundice
painful urine

Question 2

Ix and Mx of Kawasaki

Answer 2

No real ix for kawaski -mainly clinical
but has signs on BT
acute phase proteins -CRP, ESR, ferritin UP high (return normal during recoevery)
if low, question Kawasaki

can have aneamia and high WBC
LFT for hepatitis, CXR for peri/pneumonitis, ECG

Subacute -platelet are RISEN

echo monitoring of coronary artery aneurysm until stop progressing

Mx
IVIG, high dose aspirin
2nd line -steroids + aspirin
can even use infliximab/ other

If no risk factors afer 10 days -low dose aspirin

when Z score >2.5 (that aneurysm size) <5 -antiplatlets
Score >5 <10 0-2 antiplatelet agents
>10 - 2 antipletel, anti coag, b blocker

Question 3

Complications and prognosis of Kawasakis

Answer 3

mycarditis/pericarditis -v common
Coronary aneurysms -rare but hallmakr- need to monitor

aneurysm in other places are also possible -liver, periphera;, bowel etc -monitor

prognosis is pretty good -mortllity under 0.5%
untreated itd bad