Transcript Slide 1

Kawasaki Disease in a 3 yr old
Poster by Kade Rasmussen DO, and Joseph Dougherty DO,
Kawasaki Disease (KD) has an unknown etiology. It
is a self-limited acute vasculitic syndrome. KD has a
male to female ratio of 1.5:1. The mean annual
incidence in children of non-Asian descent is 10
cases per 100,000 children younger than 5 years,
and the mean annual incidence in children of Asian
descent is 44 cases per 100,000 children younger
than 5 years. In Japan the incidence is 95 per
100,000. Death occurs in less than 1%. The largest
complication is developing coronary artery
aneurysms. This happens in about 25% of
untreated patients and about 5-10% of treated
patients.
A 34 month old male patient presents to
the ER with a couple days history of
rhinorrhea, fever, and rash to face. Oral
intake and BM had been normal,
Father described the patient having
lethargy and not acting normal. On
physical exam Pt was found to have a
petechial rash on face and lips with
some mucosal involvement, erythema
and exudate present in the tonsillar and
peritonsillar regions. He also had
anterior lymphadenopathy. There was
also some mild swelling noted in the
hands, elbows, and knees bilaterally.
CXR showed b/l perihilar pneumonia.
The patient was transferred to a tertiary
care center were the diagnosis of
Kawasaki’s disease was made.
Our patient had the following criteria for diagnosis
of KD: lymphadenopathy, rash, oral mucosal
changes and the peripheral edema. He did not
meet the criteria for the fever because it was less
than 5 days duration. The diagnosis was made
ultimately by the pediatrician at the tertiary hospital.
Treatment is 1IVIG 2g/kg given over 12 hours, and
2ASA 80-100mg/kg divided qid. The dose of the
ASA is decreased (3-5 mg/kg per day) after the
fever has resolved and continued for 2-3 months.
136 110
18
5
109
0.4
12.6
10.3
36.6
CRP 4.2
ANTI-STREPTOLYSIN O <25
SED Rate 25
3a
175
The diagnosis of KD is defined as fever of 5 days and 4
of the following:
1. Rash
2. Cervical lymphadenopathy (at least 1.5 cm in diameter)
3. Bilateral conjuctival injection
4. Oral mucosal changes
5. Peripheral extremity changes
1 Newburger, JW, Takahashi, M, Beiser, AS, et al. A single intravenous infusion of gamma globulin as compared with four infusions in the treatment of acute Kawasaki syndrome. N Engl J Med 1991;
324:1633
2 Hsieh, KS,Weng, KP, Lin, CC et al. Treatment of acute Kawasaki disease: aspirin's role in the febrile stage revisited. Pediatrics 2004; 114:e689.
3 http://www.cdc.gov/kawasaki/
http://www.pathguy.com/sol/39654.jpg, http://emedicine.medscape.com/article/965367-overview, http://www.aeped.es/infofamilia/temas/enfkawasaki.htm,
http://2.bp.blogspot.com/_fma0BqnxXI/SV7hHOl9zpI/AAAAAAAAAH0/Sbxjbdk8CGM/s200/Kawasaki+Disease.jpg, http://www.skinatlas.com/Kawasaki%20syndrome/Kawasaki4.htm