Kawasaki Facts
What is the classical diagnostic criteria of typical Kawasaki disease?
Fever ≥ 5 days AND
Eye redness, rash, erythema of the hands and feet, cervical lymphadenopathy, and changes in the oral cavity (strawberry tongue)
What does the rash of KD look like?
It can look like anything!
There is no classical KD rash, but if vesicular its probably NOT KD
What is the most common cardiovascular complication of KD?
Coronary artery aneurysm
Once diagnosis of KD is suspected, what treatment should be initiated?
IVIG and high-dose aspirin
5y/o with 6 days of fever, URI symptoms, red eyes with drainage, sore throat, and diarrhea. Patient has been learning how to swim at a summer camp this month.
Adenovirus
What is the “sixth” diagnostic criteria that many physicians also use for diagnosis? (including Dr. Arnold)
Irritability
50% of children will have significant irritability (older children with KD more commonly present with lethargy than irritability)
In the ocular manifestation of Kawasaki disease, the conjunctivitis classically spares what?
The limbus
KD causes inflammation of the vessels in the eye and the limbus area has a different blood flow pattern that is less involved in the inflammatory process in KD
How long does it take for patients with mild CA dilation to return to baseline?
6 to 8 weeks after onset of disease
What constitutes a “failure of initial treatment” and what are at least 2 options for further treatment?
Continued fever after 36 hours after initial IVIG dosing, will need to give second-line therapy, which can include: 2nd dose IVIG, steroids, anakinra, or infliximab
9 y/o with high fever for 5 days, sore throat, enlarged lymph nodes in the neck, and a fine, red, sandpaper rash in her inguinal folds. The rash desquamates 6 days later.
Scarlet fever
Kawasaki disease is due to widespread inflammation of what?
Medium sized arteries
What location is the rash of KD most likely to start?
The perineum or the diaper area
What is the z-score needed to diagnose coronary artery aneurysm or ectasia?
Z ≥ 2.5
Name one serious adverse effect of IVIG?
aseptic meningitis, hemolytic аnеmiа, transfusion reaction/transmission of bloodborne pathogens
14y/o female with 48 hours of high fever, diffuse, red, macular rash resembling sunburn that involves the palms and soles, red eyes, hypotension, and confusion. She is admitted to the PICU due to concern for septic shock.
Toxic Shock Syndrome
What country was Kawasaki disease first discovered in?
Japan
Name 3 supplemental laboratory criteria for KD diagnosis.
Albumin ≤ 3.0g/dL, Anemia for age, elevation in ALT, platelets ≥ 450,000, WBC ≥ 15,000, sterile pyuria, and elevated CRP or ESR
At what time should you repeat the ECHO outpatient?
One to two weeks and again four to six weeks after discharge
How long should you postpone vaccines after giving IVIG?
11 months
12y/o male with PMH of epilepsy presents with fever, sore throat, red eyes, and painful erythematous rash that started on the face and has moved down his body. Rash now includes the mucosal surfaces of his mouth and nose.
Steven Johnson syndrome
What was Kawasaki disease previously called?
(Hint the acronym is MLNS)
What dermatological manifestation can be seen months after Kawasaki Disease?
Beau lines (transverse line across the nails) which that follows the desquamation of the hands
What age group is at high risk for developing coronary artery abnormalities?
Infants with ≤ 6 months
Which medication should be avoided with concomitant ASA treatment in patients with coronary artery aneurysms?
Ibuprofen
7y/o female with URI symptoms 2 weeks ago. Now presenting with 5 days of fever, red eyes, strawberry tongue, vomiting, and diarrhea. Now with elevated inflammatory markers and soft blood pressures.
Multisystem inflammatory syndrome in children