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:

Bilateral conjunctival injection

 limbic sparing

Oral mucosa changes

 erythema of lips or OR

 strawberry tongue

 dry cracked lips

Peripheral extremity changes

 edema

 erythema

 periungual desquamation

Rash

Cervical LAD >1.5cm

C- conjunctivitis

R- rash

A- aneurysm

S- strawberry tongue

H- hands feet changes

Associated Sx:

 High ESR/WBC/LFTs/Plts

 Aseptic meningitis

 Urethritis, Anemia

 RUQ pain, big GB (hydrops)

 Irritability, N/V/D

Work-Up

Labs:

 CBC/Diff/SPA/ALT/TBili

 Blood Cx and UA

 ECG

 Echo (Coronaries, LV, Valves)

 Red Top "Kawasaki Serum to CBR"

Treatment

Orders:

 Vitals:

   q6h pre ASA doses

   During IVIG/ Steroid Rx:

     q15min x1h

     q30min x1h

     q1h for remainder

     cardiac monitor during infsn

Consults:

 Full cardio

Meds:

 ASA 20mg/kg q6h until afebrile

 Benadryl 1mg/kg IV pre IVIG

 IVIG 2G/kg IV over 8-12h

 IV methylprednisolone 30mg/kg [max 1.5gm] over 3 hrs before IVIG

   pulse (shorter duration of fever, shorter hospital stay, lower ESR at 6 weeks.  Sundel et al, J Peds 142 June 2003)

Disposition

 F/U w/ cardio

 Cont ASA at high dose, switch to ASA 3-5mg/kg/day once afebrile for 48h

Source

Adapted from Donaldson, Pani