Kawasaki disease

Question 1

Symptoms

Answer 1

Continuous fever for 5+ days, resistant to antipyretics
Conjunctivitis
Cervical lymphadenopathy
Strawberry tongue
Peeling rashes on hands and feet
Bright red, cracked lips

Question 2

Investigation

Answer 2

Clinical diagnosis

Question 3

Management

Answer 3

High dose aspirin + IVIG
Perform echo

Question 4

Why is it unusual that aspirin is being given in Kawasaki disease?

Answer 4

Because aspirin can cause Reye’s syndrome in children

Question 5

What is Reye’s syndrome?

Answer 5

Reaction to aspirin after a flu-like infection or chicken pox, leading to brain and liver damage.

Mitochondria in liver cells become damaged. Liver doesn’t filter out ammonia, so this builds up in the brain, leading to encephalopathy, cerebral oedema.

Question 6

Why do you do an echo?

Answer 6

Coronary artery aneurysm risk

Question 7

Second line management if IVIG is not used

Answer 7

Corticosteroids + Infliximab

Question 8

Third line option

Answer 8

Plasma exchange + cyclosporin

Question 9

Second line management if IVIG is not used

Answer 9

Corticocsteroids + Infliximab

Question 10

How do you follow up on this child? What is this based on?

Answer 10

Low risk - 8w of aspiring then no follow up
Moderate risk - low dose aspirin until MI risk declines, echo follow up yearly
High risk - low dose aspirin and ECG and ECHO every two years.
May also need clopi or warfarin