Kawasaki disease

Question 1

What are the clinical feeatures of Kawasaki disease?

Answer 1

CRASH & BURN

Fever > 5 days (burn) + 4/5

• Conjunctival injection bilaterally (non purulent, limbus sparing) i.e. bilateral non suppurative conjunctivitis
• Rash (polymorphous, anything except vesicular rash)
• Adenopathy (cervical LN >1.5cm, non tender, usually unilateral)
• Strawberry tongue (& mocosal involvement e.g. lips)
• Hands (early- palmar erythema & oedema, late- desquamation)

<4/5 requirements required if CA aneurysms are found on 2D echo/ angiography

Question 2

What are the investigations to be conducted for Kawasaki disease?

Answer 2

• NCNC anaemia, ↑WCC (+left shift), reactive thrombocytosis
• Raised CRP
• **Urinalysis: pyuria
• ↑AST ALT
• Anti-endothelial cell autoab

Question 3

What is the management of kawasaki disease?

Answer 3

Single dose of high-dose IVIg (2 g/kg) – preferably within day 10 of illness; reduces CA aneurysms (which could lead to MI)

Followed after the acute phase by aspirin 200–300 mg daily (note: aspirin is usually avoided in childhood as it is a/w Reyes syndrome (fulminant liver failure), but Kawasaki is one of notable exceptions)

No evidence for steroid use

2D echo in 2 weeks for coronary aneurysm
- give aspiring 6-8 weeks + LMWH if present