On this page
Study tools
Write your answer
Saved on this device. No marking — you are the marker.
Stem
A 2-year-old child has had high fever for 6 days, unresponsive to paracetamol and antibiotics. Examination: bilateral red eyes (no discharge), cracked red lips, strawberry tongue, generalized maculopapular rash, and swollen red palms and soles. Cervical lymph node 2.5cm on the right.
Questions
a) What is the diagnosis? (1 mark)
Kawasaki disease: fever over 5 days + 5 of 5 diagnostic criteria (bilateral conjunctivitis, oral changes, rash, extremity changes, lymphadenopathy).
b) List the five diagnostic criteria. (3 marks)
- Bilateral non-purulent conjunctivitis (red eyes, no discharge)
- Oral changes (cracked red lips, strawberry tongue, pharyngeal injection)
- Polymorphous rash (not vesicular)
- Extremity changes (acute: erythema/edema of palms and soles; subacute: periungual desquamation)
- Cervical lymphadenopathy (over 1.5cm, usually unilateral)
Diagnosis requires fever over 5 days PLUS 4 of 5 criteria (this child has all 5).
c) What is the treatment and the rationale for urgency? (3 marks)
IVIG 2g/kg IV (single infusion over 10 to 12 hours) + aspirin (high-dose 30 to 50mg/kg/day for anti-inflammatory, then low-dose 3 to 5mg/kg/day for anti-platelet).
Urgency: treatment must be started within the first 10 days of illness to prevent coronary artery aneurysm. IVIG reduces aneurysm risk from 25% (untreated) to 3 to 5% (treated).
d) What investigation is essential at diagnosis and follow-up? (1 mark)
Echocardiogram at diagnosis (baseline coronary arteries), at 2 weeks, and at 6 to 8 weeks. Detects coronary artery aneurysm.
e) What is the risk if treatment is delayed? (2 marks)
Coronary artery aneurysm (25% untreated): weakens arterial wall → thrombosis → myocardial infarction or sudden death (months to years later). Kawasaki is the leading cause of acquired heart disease in children in developed countries. Also risk: myocarditis, pericarditis, arrhythmias.