Kawasaki

Reference:

• Kawasaki - RCH

Background

• Second commonest vasculitis in kids behind HSP

• Medium vessel vasculopathy, any organ can be affected

• Lack of treatment leads to coronary artery aneurysm in 25%

• 75% of cases occur < 5 years

• Can present without ALL diagnostic criteria

Assessment

KD Criteria = fever for 5 days plus 4/5 of

• Eyes - Bilateral, non-exudative, painless conjunctival injection, with limbic sparing

• Rash - Red, polymorphous, trunks and limbs, variable but commonly maculopapular similar to EM or Scarlet Fever

• Mouth - Red, dry, cracked lips with diffuse red oropharynx including strawberry tongue

• Limbs - Red, painful swelling hands and feet that desquamates in week 2

• Lymph nodes - Cx lymphadenopathy, unilateral, tender, >1.5cm

Common additional findings

• Neuro - Irritability, aseptic meningitis

• GIT - Abdo pain, vomit, diarrhoea

• Joint - Arthralgias and arthritis

• Dysuria

Incomplete KD

• Sick kid with history suspicious for KD but doesn’t fulfil criteria

• Bloods tests for CRP and ECR

  • If low, serial bloods and echo

  • If high, and 3 or more abnormal other bloods or echo then treat

Ddx

• Group A Strep

• Virus including EBV, CMV, Adenovirus, HHV-6, SARS-CoV2

• JIA

• Sepsis

• Toxic shock syndrome

• Steven John Syndrome

• Drug reaction

• Malignancy

Treatment

• Echo at presentation, then 2 weeks and 6 weeks

• All patients FBC, CRP, ESR, UEC, LFT, Blood culture, ASOT, Serum stored, Urine MCS, COVID-19 swab, ECG

• IVIg as a single dose

• Aspirin 3-5mg/kg orally daily until normal echo, minimum 6 weeks

• Corticosteroids (limited evidence)