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Kawasaki Disease

Kawasaki Disease is a Medium-vessel vasculitis. It's more common in Asian males (particularly Japanese and Korean).


A key complication here is Coronary Artery Aneurysm.


Presentation

  • Persistent high fever

  • Widespread erythematous maculopapular rash

  • Strawberry tongue

  • Cervical lymphadenopathy

  • Bilateral conjunctivitis

  • Desquamation – skin peeling on palms and soles

“Kawasaki disease (A) Bilateral, non-exudative conjunctival injection with perilimbal sparing. (B) Strawberry tongue and bright red, swollen lips with vertical cracking and bleeding. (C) Erythematous rash involving perineum. (D) Erythema of the palms, which is often accompanied by painful, brawny edema of the dorsa of the hands. (E) Erythema of the soles, and swelling dorsa of the feet. (F) Desquamation of the fingers. (G) Erythema and induration at the site of a previous vaccination with Bacille Calmette-Guérin (BCG). (H) Perianal erythematous desquamation.” © Dong Soo Kim CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0/)
“Clinical manifestations and time course of Kawasaki disease” © Maen K Househ CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0/)

Management

The patient should have an urgent Echo done to check and monitor for coronary aneurysms.


The patient should be started on:

  • High-dose Aspirin – reduces risk of thrombosis

  • IVIG – reduces risk of coronary artery aneurysms


N.B. Aspirin is usually avoided in children due to the risk of Reye’s Syndrome (swelling of brain and liver). This is one of the very few cases in which the benefit outweighs the risk.




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