Rheumatology - Kawasaki Disease

Question 1

What is Kawasaki disease?

Answer 1

Mucocutaneous lymph node syndrome

Systemic, medium-sized vessel vasculitis

Question 2

Who is affected by Kawasaki disease?

Answer 2

Young kids under 5

More common in Asian boys particularly Japanese and Korean

Question 3

What causes Kawasaki disease?

Answer 3

No clear cause or trigger

Question 4

What is a key complication of Kawasaki disease?

Answer 4

Coronary artery aneurysm

Question 5

What are the clinical features of Kawasaki disease?

Answer 5

• Persistent high fever for more than 5 days
• Widespread erythematous maculopapular rash
• Desquamation on palms and soles
• Strawberry tongue
• Cracked lips
• Cervical lymphadenopathy
• Bilateral conjunctivitis

Question 6

What investigations are used in Kawasaki disease?

Answer 6

-** FBC** - anaemia, leucocytosis and thrombocytosis
- LFTs - hypalbuminaemia and raised liver enzymes
- Raised ESR in particular and CRP
- Urinalysis - raised WCC without infection
- ECG- coronary artery pathology

Question 7

What is the disease course like in Kawasaki disease?

Answer 7

Acute phase
Child is most unwell, lasting for 1-2 weeks
- Fever
- Rash
- Lymphadenopathy

Subacute phase
Acute symptoms settle, lasting for 2-4 weeks
- Desquamation
- Arthralgia
- Coronary artery anerusym formation risk

Convalescent stage
Symptoms settle, blood tests return to normal and coronary aneurysms regress
2-4 weeks

Question 8

How is Kawasaki disease managed?

Answer 8

High dose aspirin
Reduces risk of thrombosis

IV immunoglobulins
Reduce risk of coronary artery aneurysms

Close follow up with echocardiograms to monitor for coronary artery aneurysms

Kawasaki disease is one of the few scenarios where aspirin is used in kids, usually avoided due to Reye’s syndrome