KAWASAKI DISEASE
Carreon G., Carreon J., Casaul J.R., Coronado M.C., Corpuz D., Credo C., Danguilan M.C.,
De Gracia C.
AIM:
• Review the clinical presentations of Kawasaki disease, its progression, serious complications and management.
• Discuss the D/Dx of Kawasaki disease.
S>
• 14 m/o, M, from Antipolo City, Filipino, Catholic, born on May 21, 2010
• 1st admission at this institution (May 24, 2011)
CC:
• Request for transfer of service, T/C Kawasaki Disease
0 1 2 3 4 5 6 7 8 9
37
37.5
38
38.5
39
39.5
40
40.5
Temperature
irritabilitydiarrhea
rashes
unilateralcervicallymph-adenopathy
conjunctivalinjection
chills
swelling ofhands and feet
perinealdesquamation
dry, crackedlipsstrawberry
tongue
vomiting
Paracetamol Cefuroxime Aspirin IVIG,zinc sulfate
Day of Illness
1st DOI (5 days PTA) - 5/19/11
• (+) Fever (38.3-38.5 °C)• (+) Decreased appetite/activity• MEDs:Paracetamol drops (12 mkdose, 120mg/5mL,
5mL, q4h) –slight relief
0 1 2 3 4 5 6 7 8 9
37
37.5
38
38.5
39
39.5
40
40.5
Temperature
irritabilitydiarrhea
rashes
unilateralcervicallymph-adenopathy
conjunctivalinjection
chills
swelling ofhands and feet
perinealdesquamation
dry, crackedlipsstrawberry
tongue
vomiting
Paracetamol Cefuroxime Aspirin IVIG,zinc sulfate
Day of Illness
2nd DOI (4 days PTA) – 5/20/11
• (+) Fever (38.9)• LABs:CBC
U/A: light yellow, clear, s.g 1.010, (-) protein, (-) sugar, 0 RBC, 0-1 WBC, rare epithelial cells
CXR: 1° Complex TB infection
Hgb 11.5
Hct 0.377RBC 4.36
WBC 30
Neutrophils 72
Lymphocytes 19.6
Platelet 417
2nd DOI (4 days PTA) – 5/20/11
• MEDs:Paracetamol drops, 12 mkdoseCefuroxime, 105 mkd, 350 mg IV, q8hBudesoniodeSalbutamol
0 1 2 3 4 5 6 7 8 9
37
37.5
38
38.5
39
39.5
40
40.5
Temperature
irritabilitydiarrhea
rashes
unilateralcervicallymph-adenopathy
conjunctivalinjection
chills
swelling ofhands and feet
perinealdesquamation
dry, crackedlipsstrawberry
tongue
vomiting
Paracetamol Cefuroxime Aspirin IVIG,zinc sulfate
Day of Illness
3rd DOI (3 days PTA) – 5/21/11
• (+) Fever (40°C)• (+) Diarrhea (greenish, soft, 3-5 episodes)• (+) Maculopapular, pruritic rash
(hands>trunks>head>lower extremities)• LABs:Fecalysis: brown, soft, 0-2 pus, 0-1 RBC, moderate
bacteria• MEDs: same
0 1 2 3 4 5 6 7 8 9
37
37.5
38
38.5
39
39.5
40
40.5
Temperature
irritabilitydiarrhea
rashes
unilateralcervicallymph-adenopathy
conjunctivalinjection
chills
swelling ofhands and feet
perinealdesquamation
dry, crackedlipsstrawberry
tongue
vomiting
Paracetamol Cefuroxime Aspirin IVIG,zinc sulfate
Day of Illness
4th DOI (2 days PTA) – 5/22/11
• (+) Fever, rash, diarrhea (4-5 episodes)• (+) CLAD (R submandibular area, 2cm)• (+) bilateral, nonpurulent conjunctival
injections with perilimbal sparing
4th DOI (2 days PTA) – 5/22/11• LABs: CBC
ESR: 65 CRP: 48 U/A: dark yellow, sl. Turbid, s.g. 1.020, trace albumin, (-) sugar, pH 6, 2-4
pus, 0-1 RBC, few epithelial cells, few bacteria, few amorphous materials• MEDs: same
Hgb 10.2
Hct 31RBC 3.95
WBC 5
Neutrophils 57
Lymphocytes 43
Platelet 409
Primary Impression
• Kawasaki disease
5th DOI (1 day PTA) – 5/23/11
• Sx persisted• (+) stawberry tongue• MEDs: same
0 1 2 3 4 5 6 7 8 9
37
37.5
38
38.5
39
39.5
40
40.5
Temperature
irritabilitydiarrhea
rashes
unilateralcervicallymph-adenopathy
conjunctivalinjection
chills
swelling ofhands and feet
perinealdesquamation
dry, crackedlipsstrawberry
tongue
vomiting
Paracetamol Cefuroxime Aspirin IVIG,zinc sulfate
Day of Illness
6th DOI (DOA) – 5/24/11
• Sx persisted• (+) fever and chills (40.1°)• (+) perineal desquamation• (+) swelling of hands and feet• 37.2-39.6°C>123-180>26-45 + 4BM
6th DOI (DOA) – 5/24/11• LABs:• CBC
Re-reading of CXR (wet read) Pneumonia LU and both LLF Mild pulmonary hyperinflation
Hgb 96
Hct 27
RBC 3.6
WBC 23.9
Neutrophils 89
Lymphocytes 11
Platelet 571
6th DOI (DOA) – 5/24/11
*seen by a pediatric infectious disease specialist>> KAWASAKI DISEASE
• MEDs:Paracetamol, 12 mkdoseASA, 80 mkd (100mg/tab, 2 tabs, q6h)Cefuroxime, 100 mkd (250 mg IV, q6h)
0 1 2 3 4 5 6 7 8 9
37
37.5
38
38.5
39
39.5
40
40.5
Temperature
irritabilitydiarrhea
rashes
unilateralcervicallymph-adenopathy
conjunctivalinjection
chills
swelling ofhands and feet
perinealdesquamation
dry, crackedlipsstrawberry
tongue
vomiting
Paracetamol Cefuroxime Aspirin IVIG,zinc sulfate
Day of Illness
7th DOI (2nd HD) – 5/25/11
• (+) conjunctival injection• Improvement on the rash• Progression of perineal desquamation (upto
lower back)• (+) dry, cracked lips• 90-100/60>131-156>35-49>36.2-38.8 + 1 BM• MEDs: same
0 1 2 3 4 5 6 7 8 9
37
37.5
38
38.5
39
39.5
40
40.5
Temperature
irritabilitydiarrhea
rashes
unilateralcervicallymph-adenopathy
conjunctivalinjection
chills
swelling ofhands and feet
perinealdesquamation
dry, crackedlipsstrawberry
tongue
vomiting
Paracetamol Cefuroxime Aspirin IVIG,zinc sulfate
Day of Illness
8th DOI (3rd HD) – 5/26/11
• (-) conjunctival injection• Improvement on the rash• (+) perineal desquamation up to the lower
back• Improvement on strawberry tongue• (+) dry cracked lips
8th DOI (3rd HD) – 5/26/11
• LABs:2D-echo:
R coronary artery dilated (0.21 cm proximally, 0.18 cm distally)
L coronary artery dialted (0.22 cm proximally)Mild pulmonic and tricuspid regurgitationMild pulmonary HTN, pulmonary artery pressure at 51
mmHgSlight L ventricular hypertrophyFair L ventricular systolic fxn, EF 56 mmHgMinimal pericardial effusion noted posteriorly
8th DOI (3rd HD) – 5/26/11
• LABs:Re-reading of CXR (official result)
Sub-optimal for evaluation d/t motion artifacts. Repeat study suggested.
• MEDs:Paracetamol, 12 mkdCefuroxime, 100 mkdASA, 100 mkd IVIGZn sulfate drops, 5.5 mkd, 27.5mg/mL, 2mL, OD
0 1 2 3 4 5 6 7 8 9
37
37.5
38
38.5
39
39.5
40
40.5
Temperature
irritabilitydiarrhea
rashes
unilateralcervicallymph-adenopathy
conjunctivalinjection
chills
swelling ofhands and feet
perinealdesquamation
dry, crackedlipsstrawberry
tongue
vomiting
Paracetamol Cefuroxime Aspirin IVIG,zinc sulfate
Day of Illness
Recommended
