Kawasaki Disease

Unusual

Step 1: View clinicals

A 10-month-old girl presents with high fever for 8 days, which is remittent in nature and associated with irritability. She was treated with antibiotics for the past 4 days, with little or no improvement in symptoms. She was previously well and was breastfed up to 6 months of age.


Step 2: Order all relevant investigations

Full Blood Count

WBC/DC: 13,500/mm3 N: 70%, L: 25% Hb: 12g/dl Platelets: 620,000/mm3

Septic Screen

Her blood and urine cultures are negative. The chest x-ray appears normal.

X-ray neck - lateral

The x-ray appears normal, with no evidence of pharyngeal soft-tissue thickening.

Echocardiogram

The echocardiogram shows perivascular brightening and cuffing of the right coronary artery, and irregularity of the inner wall of the left anterior descending artery. No structural or valvular cardiac defects are noted, while the ejection fraction is > 70%


Step 3: Select appropriate management

Continue Antibiotics
Paracetamol
Aspirin
IV Immunoglobulin


Score: ★★☆