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
• Non-thrombocytopaenia
  • Vasculitis
    • Henoch Schonlein pupura
    • Wegener’s granulomatosis
  • Hand, foot and mouth disease (Coxsackie virus)
  • Meningococcemia

Investigations

• Anti-streptolysin O test
• Anti DNAase B
• LFT
• FBC
• Echocardiogram

Treatment

• Paediatric consult
• Admit to hospital
• Immunoglobulin IV (~10days)
• Aspirin

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