Imagine: You are a 3 year old child. The world is your oyster. You are young (very young), carefree, and you have a need for speed. Times are good. Until you get a fever.. for 6 freakin’ days! Your whole body just ain’t like it use to be–you have a rash, a fever, and painful hands, and your lips are so dry and painful that you can’t even kiss your Hello Kitty doll goodnight. You were cruising through childhood in your decked-out Hello Kitty Mobile so fast that you CRASHed and BURNed. Meow.
What is this disease? What causes it?
Kawasaki disease!
KD is a vasculitis, not an infectious disease, and the exact cause is unknown. Incidence is between 5 months – 5 years with peak at 18-24 months.
What are the criteria for diagnosis?
You can remember with the mnemonic CRASH and Burn
- Conjunctivitis (nonexudative, bilateral)
- Rash (polymorphous/nonspecific)
- Adenopathy (cervical nodes)
- Strawberry tongue/ mucosal changes – “mucositis” with cracked red lips or oral erythema (don’t necessarily need “strawberry tongue,” but there must be some mucosal/oral inflammation)
- Hand edema or erythema; may also desquamate and can involve feet
- “Burn” = fever. Feel the bern, y’all.
Criteria for classic disease are fever for 5 days plus 4 or the 5 criteria above.
Patients can also have incomplete disease defined by fever for 5 days, at least 2 criteria, an elevated ESR (> 40) OR CRP (>3.0) PLUS positive echo OR 3 (or more) lab findings below:
- albumin low (< 3.0)
- anemia
- elevated ALT
- increased platelets (> 450K after fever for 7 days)
- increased WBC (>12K)
- pyuria
What is the treatment and ED dispo?
Admission. Remember they are at risk of coronary aneurysm and need high-dose aspirin therapy: 80mg/kg/day divided q6 hours for 2 weeks, followed by 3-5mg/kg/day for 6 weeks. They also should get IVIG. They will need an echo as an inpatient to assess for aneurysm and wall abnormalities.
References
Thank you Dr. Willis and Buzzfeed for your endless amounts of critical knowledge.
-Kitty Out-
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Emergency Medicine Resident at Kings County Hospital / SUNY Downstate
@KBirnbaumMD
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