A 2 yo previously healthy M presents with fever for 5 days, red cracked lips and general irritability.

Questions to Ask

  • Pattern of fever?
  • Associated URI symptoms?
  • Conjunctivitis?
  • Lymphadenopathy?
  • Rash?
  • Extremity changes (hand/foot swelling)?

History & Physical Exam

  • 3 days ago PMD noted red eyes with limbic sparing.
  • This AM feet appeared puffy.
  • A macular papular rash is present over torso and extremities, sparing palms/soles.
  • On exam, he has prominent linular papillae and red, cracked lips.
  • You further note that the child is cranky and cries throughout exam.

Recommended Workup

  • Labs:
    • CBC with differential, Complete metabolic panel
    • ESR, CRP
    • UA with microscopy
    • Infectious workup as appropriate (blood culture, urine culture, viral panel)
    • Antibody testing that might be needed prior to IVIg administration
  • Echocardiogram to look for coronary ectasia

Referrals

  • Admission for treatment of KD

Treatment

Key recommendations for the treatment of Kawasaki Disease from the ACR Journals

Reference: https://acrjournals.onlinelibrary.wiley.com/doi/10.1002/acr.24838