Kawasaki Disease in a 3 yr old

1

Kawasaki Disease in a 3 yr old Poster by Kade
Rasmussen DO, and Joseph Dougherty DO,
Case Summary
Discussion
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 Kawasakis disease
was made.
Kawasaki Disease (KD) has an unknown etiology.
It is a self-limited acute vasculitic syndrome.
KD has a male to female ratio of 1.51. 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. 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.
Diagnosis Criteria

• The diagnosis of KD is defined as 3a fever of 5
  days and 4 of the following
• Rash
• Cervical lymphadenopathy (at least 1.5 cm in
  diameter)
• Bilateral conjuctival injection
• Oral mucosal changes
• Peripheral extremity changes

12.6
110
136
5
175
10.3
109
36.6
0.4
18
CRP 4.2 ANTI-STREPTOLYSIN O lt25 SED Rate 25
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
3241633 2 Hsieh, KS,Weng, KP, Lin, CC et al.
Treatment of acute Kawasaki disease aspirin's
role in the febrile stage revisited. Pediatrics
2004 114e689. 3 http//www.cdc.gov/kawasaki/
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