E) All of the above patients are concerning for Kawasaki’s disease
Classic Kawasaki’s is characterized by > 5 days of fever and > 4 of 5 of CRASH: conjunctivitis (usually non-exudative, bilateral), rash, adenopathy (usually single cervical node > 1.5cm), strawberry tongue (or other oral change such as cracked, dry, peeling, erythematous lips), hand/foot changes (edema, erythema, desquamation 2-3 weeks after fever onset). However, incomplete Kawasaki’s can present with just 2-3 of the CRASH criteria, or in young infants with fever alone. Lab screening is recommended if incomplete Kawasaki’s is suspected, including for all infants <= 6mo old with fever 7 days or longer and no alternative explanation. If CRP > 3 or ESR > 40, obtain the following, and if 3 or more meet criteria, obtain echocardiogram and treat empirically for Kawasaki’s: anemia for age, platelets > 450,000 after 7th day of fever, albumin 15,000, urine with > 10 WBC/hpf. If meets CRP or ESR criteria but not 3 or more ancillary lab findings, reevaluate serially and perform echo if peeling develops. A Kawasaki disease-like syndrome, often with toxic shock-like symptoms as well including hypotension, is being reported in children with COVID-19.
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May 6, 2020 at 2:07 am
E) All of the above patients are concerning for Kawasaki’s disease
Classic Kawasaki’s is characterized by > 5 days of fever and > 4 of 5 of CRASH: conjunctivitis (usually non-exudative, bilateral), rash, adenopathy (usually single cervical node > 1.5cm), strawberry tongue (or other oral change such as cracked, dry, peeling, erythematous lips), hand/foot changes (edema, erythema, desquamation 2-3 weeks after fever onset). However, incomplete Kawasaki’s can present with just 2-3 of the CRASH criteria, or in young infants with fever alone. Lab screening is recommended if incomplete Kawasaki’s is suspected, including for all infants <= 6mo old with fever 7 days or longer and no alternative explanation. If CRP > 3 or ESR > 40, obtain the following, and if 3 or more meet criteria, obtain echocardiogram and treat empirically for Kawasaki’s: anemia for age, platelets > 450,000 after 7th day of fever, albumin 15,000, urine with > 10 WBC/hpf. If meets CRP or ESR criteria but not 3 or more ancillary lab findings, reevaluate serially and perform echo if peeling develops. A Kawasaki disease-like syndrome, often with toxic shock-like symptoms as well including hypotension, is being reported in children with COVID-19.