Kawasaki disease

• What is Kawasaki disease also known as?


  Mucocutaneous lymph node syndrome
• What is Kawasaki disease?


  Systemic, medium-vessel vasculitis

  Affects young children, typically under 5 yrs
• What are the RFs of Kawasaki disease?


  Male

  Japanese or Korean ethnicity

  FHx
• What are the signs & symptoms of Kawasaki disease?


  Persistent high fever (> 39), for more than 5 days

  Fatigue/'flat'

  Widespread erythematous maculopapular rash & desquamation on palms & soles

  Strawberry tongue (red tongue with large papillae)

  Cracked lips

  Cervical lymphadenopathy

  Bilateral conjunctivitis

  Oedema on hands & feet
• What is the diagnosis of Kawasaki disease based on?


  Presence of high grade fevers for more than 5 days

  + 4/5 'CREAM' features

  • Conjunctivitis (bilateral, non-exudative)
  • Rash (any non-bullous rash, occurring within 3-5 days of onset of the fever)
  • (o)Edema/Erythema & desquamation of hands & feet
  • (lymph)Adenopathy (cervical, commonly unilateral & non-tender)
  • Mucosal inflammation (strawberry tongue, oral fissures, etc)
• What is shown in the image?

  Strawberry tongue (in Kawasaki disease)

  
• What is shown in this image?

  Erythematous hands

  
• What are the DDx of Kawasaki disease?

  Scarlet fever

  Measles

  Drug Reactions

  Juvenile RA

  Toxic Shock Syndrome

  SLE
• What are the Inx for Kawasaki disease?

  Obs

  Full Hx & examination

  ECG

  Urinalysis

  Bloods (FBC, LFTs, CRP)

  Echo
• What are the 3 phases of Kawasaki disease?


  Acute phase

  • child is the most unwell with fever, rash & lymphadenopathy
  • lasts 1-2 wks

  Subacute phase

  • acute symptoms settle
  • desquamation & arthralgia
  • risk of coronary artery aneurysms forming
  • lasts 2-4 wks

  Convalescent stage

  • remaining symptoms settle
  • bloods slowly return to normal
  • coronary aneurysms may regress
  • lasts 2-4 wks
• What is the management of Kawasaki disease?


  IV immunoglobulin

  High dose aspirin

  • to reduce inflammation & prevent coronary artery aneurysms

  Regular echos -> surveillance of coronary artery aneurysms

  Closely monitored as recovering from acute episode
• What are the possible complications of Kawasaki disease?


  Coronary artery aneurysms (most concerning complications)

  Aseptic meningitis

  Arthritis

  Anterior uveitis

  Jaundice

  Pancarditis

  Sudden cardiac death

  MI