Kawasaki Disease

  • Mucocutaneous Lymph Node Syndrome
  • Children: Fever+CRASH
    • Fever for 5 days
    • Conjunctivitis
    • Rash (polymorphous)
    • Adenopathy (usually cervical)
    • Strawberry tongue (mucous membrane involvement)
    • Hands (early erythema, late desquamation)
  • “Typical” KD diagnosed with fever + 4 of the above
  • Infectious etiology?
  • 50% with extracutaneous involvement
    • Arthritis/arthralgias, diarrhea, pyuria, abdominal pain, cough, rhinorrhea, jaundice
    • Check for murmur or gallop or muffled heart sounds
  • Leukocytosis, ESR elevation, anemia, transaminitis
  • Always get an EKG and an echocardiogram
    • Prolonged QT interval, low voltage, ST-T wave changes, arrhythmia
    • Pericardial effusion, coronary aneurysm
Treatment
  • IVIg in single dose (2g/kg over 10 hours)
  • ASA 100mg/kg/day divided QID
  • Infliximab in refractory cases
  • Corticosteroids contraindicated, actually favor development of aneurysm
  • Coronary artery aneurysms in 20-25% of untreated patients