Overview
Kawasaki Disease is a uncommon systemic vasculitis disease affecting mainly children under the age of 5.
Clinical Manifestation
- <5 years old
- Irritable
- High Fever >5 days
- Conjuctivitis (bilateral non purulent)
- Rash
- polymorphous
- Maculopapular
- Erythema and oedema of hands or feet
- Adenopathy
- Mucous membranes
- Dry cracked lips
- Red tongue
- Strawberry tongue
Diagnosis
Differential Diagnosis of Purpura/Petechiae in a child
- Thrombocytopaenia
- Decreased platelet production
- Infections
- Drugs and alcohol
- Aplastic anaemia
- Leukaemia
- Myelodysplastic syndrome
- Increased platelet destruction
- Immune mediated – Immune thrombocytopaenic purpuura
- Non-immune mediated – causes of microangiopathic haemolysis (TTC, HUS, DIC, pre-eclampsia, HELLP)
- Dilutional thrombocytopaenia – from massive blood transfusion
- Distributional thrombocytopaenia – caused by splenic sequestration
- Portal hypertension
- Decreased platelet production
- Non-thrombocytopaenia
- Vasculitis
- Henoch Schonlein pupura
- Wegener’s granulomatosis
- Hand, foot and mouth disease (Coxsackie virus)
- Meningococcemia
- Vasculitis
Investigations
- Anti-streptolysin O test
- Anti DNAase B
- LFT
- FBC
- Echocardiogram
| Remember Main complication of Kawasaki disease is coronary artery aneursym. |
Treatment
- Paediatric consult
- Admit to hospital
- Immunoglobulin IV (~10days)
- Aspirin
| Side note Aspirin is not usually used for children because of the risk of Reye Syndrome (Encephalopathy + liver damage). Kawasaki is an exception. |
Ongoing management
- Education – Kawasaki is not contagious
- Follow-up with doctor for complication
Complications and Prognosis
Complications
- Coronary artery aneurysm
- As well as artery aneurysm anywhere else
- Myocardial infarction
- Pericarditis
- Myositis
