Rheumatology

Question 1

In KD, what is the risk of coronary artery aneurysms and how much does IVIG reduce this?

Answer 1

25% of untreated children develop coronary artery lesions vs. 3% to 4% in those treated with IVIG

Question 2

Name the diagnostic criteria for KD

Answer 2

At least 4 out of the 5 with fever >5 days (WARM CREAM):

• Conjunctivitis (bilateral and non-purulent)
• Mucocutaneous changes (strawberry tongue, red and chapped lips)
• Adenopathy (unilateral in cervical region, >1.5cm)
• Rash (usually truncal, maculopapular)
• Hand and feet/extremity changes (edema to hands and feet, desquamation)

Incomplete KD with fever but fewer than 4 other criteria is common in children <1 year of age

Question 3

Name the features for incomplete KD

Answer 3

• CRP >30 or ESR >40
• Greater then or equal to 3 laboratory findings:
  1) Anemia for age
  2) Plt count >450 after the 7th day of fever
  3) Albumin level <30
  4) Elevated ALT level
  5) WBC count >15
  6) Urine >10 WBC/HPF
  OR positive ECHO

Question 4

What is the treatment for KD?

Answer 4

2g/kg IVIG and then if fever persists past 48 hours can repeat
Moderate dose ASA (30-50mg/kg/d) until fever resolves and then 3-5mg/kg/d

Question 5

Name the side effects of IVIG

Answer 5

• Infection (HIV, Hepatitis C and B)
• Allergic reaction
• Hemolytic anemia
• Aseptic meningitis

Question 6

After receiving IVIG, what are the effects on vaccination?

Answer 6

Can’t receive live vaccines for 11 months after.
- Live vaccines include: rotavirus, MMRV, live intranasal influenza vaccine (flumist), certain travel vaccines (yellow fever)