Kawasaki disease (mucocutaneous lymph node syndrome)
• Almost all cases occur in children age <5 years (incidence is greatest among children of East Asian ethnicity)
clinical diagnosis:-
Fever for >5 consecutive days (minimally responsive to antipyretics)
4 of the following 5 findings:
(1. )Conjunctivitis: bilateral, nonexudative, spares limbus
(2. )Oral mucosal changes: erythema, fissured lips, “strawberry tongue”
(3. )Rash
(4.) Extremity changes: erythema, edema, desquamation of the hands and feet, usually the last manifestation
(5. )Cervical lymphadenopathy: >1.5 cm, usually unilateral, least consistent finding (<25%-50% of patients)
Supporting lab findings in patients with atypical presentation can include the following:
-
CRP , ESR -
Leukocytosis with neutrophilia
-
PC (Reactive thrombocytosis)
-
Sterile pyuria on urinalysis
Treatment:-
•Aspirin plus IVIG
Although KD is usually self-limited, treatment with aspirin and IVIG should be started within 10 days of fever onset to prevent cardiac complications.
Baseline echocardiography (in all patients with suspected KD) and repeated 6-8 weeks later to monitor complications.
Complications:-
Coronary artery aneurysms ( ~20% of untreated patients)
Myocardial infarction & ischemia.