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KAWASAKI DISEASE. Carreon G., Carreon J., Casaul J.R., Coronado M.C., Corpuz D., Credo C., Danguilan M.C., De Gracia C. AIM:. Review the clinical presentations of K awasaki disease, its progression, serious complications and management. Discuss the D/ Dx of Kawasaki disease. S>.

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kawasaki disease
KAWASAKI DISEASE

Carreon G., Carreon J., Casaul J.R., Coronado M.C., Corpuz D., Credo C., Danguilan M.C.,

De Gracia C.

slide2
AIM:
  • Review the clinical presentations of Kawasaki disease, its progression, serious complications and management.
  • Discuss the D/Dx of Kawasaki disease.
slide3
S>
  • 14 m/o, M, from Antipolo City, Filipino, Catholic, born on May 21, 2010
  • 1st admission at this institution (May 24, 2011)
slide4
CC:
  • Request for transfer of service, T/C Kawasaki Disease
slide5

Aspirin

IVIG,

zinc sulfate

Paracetamol

Cefuroxime

chills

rashes

unilateral

cervical

lymph-

adenopathy

vomiting

irritability

swelling of

hands and feet

conjunctival

injection

diarrhea

perineal

desquamation

dry, cracked

lips

strawberry

tongue

Day of Illness

1 st doi 5 days pta 5 19 11
1st DOI (5 days PTA) - 5/19/11
  • (+) Fever (38.3-38.5 °C)
  • (+) Decreased appetite/activity
  • MEDs:
  • Paracetamol drops (12 mkdose, 120mg/5mL, 5mL, q4h) –slight relief
slide7

Aspirin

IVIG,

zinc sulfate

Paracetamol

Cefuroxime

chills

rashes

unilateral

cervical

lymph-

adenopathy

vomiting

irritability

swelling of

hands and feet

conjunctival

injection

diarrhea

perineal

desquamation

dry, cracked

lips

strawberry

tongue

Day of Illness

2 nd doi 4 days pta 5 20 11
2nd DOI (4 days PTA) – 5/20/11
  • (+) Fever (38.9)
  • LABs:
  • CBC
  • U/A: light yellow, clear, s.g 1.010, (-) protein, (-) sugar, 0 RBC, 0-1 WBC, rare epithelial cells
  • CXR: 1° Complex TB infection
2 nd doi 4 days pta 5 20 111
2nd DOI (4 days PTA) – 5/20/11
  • MEDs:
  • Paracetamol drops, 12 mkdose
  • Cefuroxime, 105 mkd, 350 mg IV, q8h
  • Budesoniode
  • Salbutamol
slide10

Aspirin

IVIG,

zinc sulfate

Paracetamol

Cefuroxime

chills

rashes

unilateral

cervical

lymph-

adenopathy

vomiting

irritability

swelling of

hands and feet

conjunctival

injection

diarrhea

perineal

desquamation

dry, cracked

lips

strawberry

tongue

Day of Illness

3 rd doi 3 days pta 5 21 11
3rd DOI (3 days PTA) – 5/21/11
  • (+) Fever (40°C)
  • (+) Diarrhea (greenish, soft, 3-5 episodes)
  • (+) Maculopapular, pruritic rash (hands>trunks>head>lower extremities)
  • LABs:
  • Fecalysis: brown, soft, 0-2 pus, 0-1 RBC, moderate bacteria
  • MEDs:
  • same
slide12

Aspirin

IVIG,

zinc sulfate

Paracetamol

Cefuroxime

chills

rashes

unilateral

cervical

lymph-

adenopathy

vomiting

irritability

swelling of

hands and feet

conjunctival

injection

diarrhea

perineal

desquamation

dry, cracked

lips

strawberry

tongue

Day of Illness

4 th doi 2 days pta 5 22 11
4th DOI (2 days PTA) – 5/22/11
  • (+) Fever, rash, diarrhea (4-5 episodes)
  • (+) CLAD (R submandibular area, 2cm)
  • (+) bilateral, nonpurulentconjunctival injections with perilimbal sparing
4 th doi 2 days pta 5 22 111
4th DOI (2 days PTA) – 5/22/11
  • LABs:
  • CBC
  • ESR: 65
  • CRP: 48
  • U/A: dark yellow, sl. Turbid, s.g. 1.020, trace albumin, (-) sugar, pH 6, 2-4 pus, 0-1 RBC, few epithelial cells, few bacteria, few amorphous materials
  • MEDs: same
primary impression
Primary Impression
  • Kawasaki disease
5 th doi 1 day pta 5 23 11
5th DOI (1 day PTA) – 5/23/11
  • Sx persisted
  • (+) stawberry tongue
  • MEDs: same
slide17

Aspirin

IVIG,

zinc sulfate

Paracetamol

Cefuroxime

chills

rashes

unilateral

cervical

lymph-

adenopathy

vomiting

irritability

swelling of

hands and feet

conjunctival

injection

diarrhea

perineal

desquamation

dry, cracked

lips

strawberry

tongue

Day of Illness

6 th doi doa 5 24 11
6th DOI (DOA) – 5/24/11
  • Sx persisted
  • (+) fever and chills (40.1°)
  • (+) perineal desquamation
  • (+) swelling of hands and feet
  • 37.2-39.6°C>123-180>26-45 + 4BM
6 th doi doa 5 24 111
6th DOI (DOA) – 5/24/11
  • LABs:
  • CBC
  • Re-reading of CXR (wet read)
    • Pneumonia LU and both LLF
    • Mild pulmonary hyperinflation
6 th doi doa 5 24 112
6th DOI (DOA) – 5/24/11

*seen by a pediatric infectious disease specialist>> KAWASAKI DISEASE

  • MEDs:
  • Paracetamol, 12 mkdose
  • ASA, 80 mkd (100mg/tab, 2 tabs, q6h)
  • Cefuroxime, 100 mkd (250 mg IV, q6h)
slide21

Aspirin

IVIG,

zinc sulfate

Paracetamol

Cefuroxime

chills

rashes

unilateral

cervical

lymph-

adenopathy

vomiting

irritability

swelling of

hands and feet

conjunctival

injection

diarrhea

perineal

desquamation

dry, cracked

lips

strawberry

tongue

Day of Illness

7 th doi 2 nd hd 5 25 11
7th DOI (2nd HD) – 5/25/11
  • (+) conjunctival injection
  • Improvement on the rash
  • Progression of perineal desquamation (upto lower back)
  • (+) dry, cracked lips
  • 90-100/60>131-156>35-49>36.2-38.8 + 1 BM
  • MEDs: same
slide23

Aspirin

IVIG,

zinc sulfate

Paracetamol

Cefuroxime

chills

rashes

unilateral

cervical

lymph-

adenopathy

vomiting

irritability

swelling of

hands and feet

conjunctival

injection

diarrhea

perineal

desquamation

dry, cracked

lips

strawberry

tongue

Day of Illness

8 th doi 3 rd hd 5 26 11
8th DOI (3rd HD) – 5/26/11
  • (-) conjunctival injection
  • Improvement on the rash
  • (+) perineal desquamation up to the lower back
  • Improvement on strawberry tongue
  • (+) dry cracked lips
8 th doi 3 rd hd 5 26 111
8th DOI (3rd HD) – 5/26/11
  • LABs:
  • 2D-echo:
    • R coronary artery dilated (0.21 cm proximally, 0.18 cm distally)
    • L coronary artery dialted (0.22 cm proximally)
    • Mild pulmonic and tricuspid regurgitation
    • Mild pulmonary HTN, pulmonary artery pressure at 51 mmHg
    • Slight L ventricular hypertrophy
    • Fair L ventricular systolic fxn, EF 56 mmHg
    • Minimal pericardial effusion noted posteriorly
8 th doi 3 rd hd 5 26 112
8th DOI (3rd HD) – 5/26/11
  • LABs:
  • Re-reading of CXR (official result)
    • Sub-optimal for evaluation d/t motion artifacts. Repeat study suggested.
  • MEDs:
  • Paracetamol, 12 mkd
  • Cefuroxime, 100 mkd
  • ASA, 100 mkd
  • IVIG
  • Zn sulfate drops, 5.5 mkd, 27.5mg/mL, 2mL, OD
slide27

Aspirin

IVIG,

zinc sulfate

Paracetamol

Cefuroxime

chills

rashes

unilateral

cervical

lymph-

adenopathy

vomiting

irritability

swelling of

hands and feet

conjunctival

injection

diarrhea

perineal

desquamation

dry, cracked

lips

strawberry

tongue

Day of Illness