Kawasaki disease

Diagnosis

A. Fever >38.5 (101.3) x >4dys

AND

B. 4 of the following:

1. Extremity edema/erythema/desquamation
2. Polymophous exanthem
3. Bilat conjunctival injection
4. Lip/oral chages (red lips, straberry tongue)
5. Cervical LAD (>1.5cm diam, usually unilat)

Also associated with platlets >1k

CDC Dx criteria

Fever >5 days and 4/5 of:

1. Bilateral conjunctival injection
   1. limbic sparing
2. Oral mucosa changes
   1. erythema of lips or OR
   2. strawberry tongue
   3. dry cracked lips
3. Peripheral extremity changes
   1. edema
   2. erythema
   3. periungual desquamation
4. Rash
5. Cervical LAD >1.5cm

CRASH

C- conjunctivitis

R- rash

A- aneurysm

S- strawberry tongue

H- hands feet changes

Associated Sx

1. High ESR/WBC/LFTs/Plts
2. Aseptic meningitis
3. Urethritis, Anemia
4. RUQ pain, big GB (hydrops)
5. Irritability, N/V/D

Work-Up

1. CBC/Diff/SPA/ALT/TBili
2. Blood Cx and UA
3. ECG
4. Echo (Coronaries, LV, Valves)
5. Red Top "Kawasaki Serum to CBR"

Treatment

1. Vitals:
   1. q6h pre ASA doses
   2. During IVIG/ Steroid Rx:
      1. cardiac monitor during infsn
      2. q15min x1h
      3. q30min x1h
      4. q1h for remainder
2. Consults:
   1. Full cardio
3. Meds:
   1. ASA 20mg/kg q6h until afebrile
   2. Benadryl 1mg/kg IV pre IVIG
   3. IVIG 2G/kg IV over 8-12h
   4. IV methylprednisolone 30mg/kg [max 1.5gm] over 3 hrs before IVIG
      1. pulse = shorter duration of fever, shorter hospital stay, lower ESR at 6 weeks

Disposition

1. F/U w/ cardio
2. Cont ASA at high dose, switch to ASA 3-5mg/kg/day once afebrile for 48h

Source

Adapted from Donaldson, Pani Sundel et al, J Peds 142 June 2003