Kawasaki disease
Definition
Epidemiology
Autoimmune disorder
causing vasculitis in
young children
Children 6m to 5y
Rare
Pathophysiology
Clinical
presentation
Diagnosis
Management
Examination
Investigations
History
Bloods
FBC (high Plts), CRP/ESR (high), U+E, LFT (high bili, AST)
Autoimmune screen (nil)
Bedside
Obs (fever)
ECG
Imaging
ECHO: may have pericardial effusion, myocardial dysfunction,
valve dysfunction, coronary aneurysms
Angiography/MRI: if coronary arteries abnormal
to define coronary aneurysms
Fever
Aetiology
Unclear aetiology
Phases
Subacute
From end of fever to weeks 4-6
CA aneuryms (causing MI and death)
Digital desquamation, conjunctival injection
Convalescent
Resolution of signs and inflamm markers
Acute febrile
1-2wk
Fever and major signs
Conjunctivitis
Bilateral, non-exudative
Red swollen hands and feet
Red rash
Truncal, well defined erythematous
Perineal, desquamating, erythematous
Red swollen tongue
Strawberry tongue
Complications
Coronary artery aneurysms
MI
Sudden death
Derm
Erythematous truncal/perineal rash
Erythematous, swollen hands and feet
ENT
Strawberry tongue
Ocular
Bilateral, non-exudative conjunctivitis
Cardio
Murmur (valve regurgitation)
Pericardial rub (pericarditis)
PMH
Growth and development
Vaccinations
Known medical conditions
DH
Meds, allergies
POH
Bloods, scans, growth, gestation,
delivery, complications
FH
Autoimmune disease, vasculitis
PC/HPC
Fever, rashes, swollen tongue/hands/feet, conjunctivitis
SH
Living arrangements, school/nursery
Conservative
Information, advice, support
Admit and refer to paeds
Medical
IV Ig
Indication: ASAP <10d onset
MOA: reduces inflammation and
risk of CA aneurysms
Steroids
Indication: unresponsive to IV Ig
E.g. prednisolone IV
Prognosis
Good with prompt tx
Mortality 1%