KD case study
Jong is a 2 year old Japanese-Korean male presenting with 5 days of fever up to 39 degrees C (102.2 degrees F). On the second day of illness, he developed red lips and an erythematous maculopapular rash over his torso. By the third day of illness, his conjunctivae were injected without exudates, his rash involved his extremities, and he developed a strawberry tongue. On the fourth day of illness, he had edema to his hands and feet with a diffuse red-purple discoloration over the palms and soles. His lips were now cracked and bleeding. He was noted to be irritable and fussy, with decreased oral intake.
Exam: VS T 39.5, P 130, RR 40, BP 100/60, oxygen saturation 100% in room air. Weight and height are at the 25th percentile. He is alert and slightly fussy, but he consoles easily and he is not lethargic. His lips are red and cracked. His tongue is bright red. His neck is supple with bilateral small lymph nodes. Heart is slightly tachycardic, with no murmurs or gallop. Lungs are clear. Abdominal exam finds no abnormalities. He has some mild edema of his hands and feet with some red-purple discoloration of the palms and soles wrapping partially around the dorsum with a sharp demarcation at the wrists and ankles. He has a generalized deeply erythematous rash which is flat with irregularly shaped pink-red lesions ranging from 1 to 7 cm in diameter, with some areas coalescing. The lesions blanch. No joint swelling is noted. He moves all extremities well.
1. What are the diagnostic criteria for KD?
* The diagnostic criteria for Kawasaki disease includes a fever of 39.9 C that lasts for at least 5 days that is unresponsive to antipyretics or antibiotics. In addition with four out of the five diagnostic criteria which include: conjunctivitis without exudates, changes in the mouth (bright red fissured lips, dry mouth and throat, strawberry colored tongue with a white coating or red bumps that are present on the posterior aspect)...