Kawasaki’s disease
Presentation
A previously healthy four-year-old male, S.T., presents to his primary care
physician with a fever of 104.1°F. Per his mother, the child has been
febrile for one week, and his fever does not seem to go away with Tylenol®
or Motrin®. Upon exam, the child has bright red, chapped lips and an
abnormally red tongue. The palms of his hand are also red and peeling.
Additionally, he appears irritable and lethargic, and his cervical lymph
nodes are swollen. The physician suspects Kawasaki's disease, an autoimmune
condition characterized by inflammation of the blood vessels, based on the
presence of the palmar rash and the “strawberry tongue.” Because of the
risk for aneurysm in patients with Kawasaki’s, he suggests that the patient
be admitted to inpatient pediatric unit at the local hospital for further
testing and evaluation.
Differential Diagnoses
Kawasaki’s disease, measles, scarlet fever
Diagnosis
Once admitted to the pediatric unit, the physicians there ordered a number
of labs to help diagnose S.T.’s condition. They obtained blood and urine
cultures to rule out the possibility of a bacterial infection, and also
tested for a slew of viral infections. All of these tests were negative.
The pt’s CRP and ESR were both elevated, and his CBC revealed a slightly
elevated white blood count. All other labs were within normal limits. Based
on the concern for Kawasaki's disease, the patient also underwent a 12-leak
EKG, which revealed normal sinus rhythm, and subsequently an echocardiogram,
which was benign.
Treatment
Diagnosis of Kawasaki's is made based on clinical presentation and the
absence of any acute infection. Based on S.T.’s classic presentation, the
patient was started on a course of intravenous immunoglobulin (IVIG), and
prescribed aspirin every 8 hours to help prevent coronary artery disease.
Outcome
Because the disease was caught early in this patient, his prognosis is
good. He responded quickly to the IVIG, and his fever resolved within two
days of admission to the hospital. His ECHO was benign, indicating that
there is little to no heart or coronary artery damage at this time. He was
discharged home with his mother four days later on daily aspirin therapy,
and will undergo a follow-up ECHO in a few weeks to ensure that his cardiac
function remains normal. He is expected to make a full recovery without any
lasting complications, but will need yearly cardiac evaluations with his
primary care physician to ensure that this is the case.
Case created by Shelby Taylor,
2011.