Kawasaki Disease (Deep Dive R20)

Kawasaki Disease











A small vessel vasculitis that affects children, usually <5 years old.











Symptoms – remember the CRASH AND BURN mnemonic!











Conjunctivitis











Rash – nonspecific morbilliform or maculopapular rash, usually on torso











Adenopathy – usually unilateral cervical lymphadenopathy











Strawberry Tongue – erythema, swelling, or cracking of lips/mucous membranes











Hands – swelling, erythema, or desquamation of the hands/feet











BURN – 5 days of fever











Diagnosis:











* COMPLETE KAWASAKI – 5 days of fever and 4/5 of the CRASH symptoms











* INCOMPLETE KAWASAKI – 5 days of fever and 2-3/5 of the CRASH symptoms, in the setting of elevated inflammatory markers (WBC, ESR, CRP)











Treatment: IVIG and High Dose Aspirin























Multisystem Inflammatory Syndrome in Children (MIS-C)











A new disease entity seen in children defined by widespread systemic inflammation affecting multiple organ systems that presents weeks after infection by COVID-19.











Symptoms:











* Persistent Fever* Skin involvement – nonspecific rash, conjunctivitis, changes to mucous membranes* GI involvement – nonspecific abdominal pain, nausea, vomiting, diarrhea* Renal involvement – acute kidney injury with elevated creatinine* Cardiac involvement – elevated troponin/pro-BNP, reduced EF, cardiogenic shock* Neuro involvement – altered mental status











Diagnosis and Treatment: Varies by hospital, but usually involves the presence of clinical symptoms along with a positive covid IgM/IgG, elevated inflammatory markers (WBC, ESR, CRP, Ferritin, DDimer), multisystem involvement (elevated troponin/proBNP, elevated creatinine, elevated LFTs, etc). These children need a stat ECHOcardiogram to rule out significant cardiac dysfunction.