pediatric rotation

2. KAWASAKI DISEASE

3. Contents
 Case study
 Summary of vasculitis
 KD
 Conclusion
 Refferences

4. Case study
This 2-year-old boy developed a high fever of 2 days’ duration.
Examination showed a miserable child with mild conjunctivitis,
a rash and cervical lymphadenopathy.
A viral infection was diagnosed and his mother was reassured.
When he presented to hospital 3 days later, he was noted to
have cracked red lips.
He was admitted and a full septic screen, including a lumbar
puncture, was performed and antibiotics started. The following
day, he was still febrile and irritable; his C-reactive protein
(CRP) had risen to 135, and ESR (erythrocyte sedimentation
rate) to 125.

5. Summary of vasculitis
immune-mediated :
 Immune complex deposition
 Antineutrophil cytoplasmic antibodies (ANCAs)
 Anti-endothelial cell antibodies
invasion of vascular walls by infectious pathogens
Physical and chemical injury

6. Vessel Disease Notes
Large
Giant-cell arteritis >50. Arteries of head.
Takayasu arteritis F <40. “Pulseless disease”
Medium
Polyarteritis nodosa Young adults. Widespread.
Kawasaki diseaseKawasaki disease <4. Coronary disease. Lymph nodes.<4. Coronary disease. Lymph nodes.
Small
Wegener granulomatosis Lung, kidney. c-ANCA.
Churg-Strauss syndrome Lung. Eosinophils. Asthma. p-ANCA.
Microscopic polyangiitis Lung, kidney. p-ANCA.

7. Kawasaki disease
Kawasaki disease is a condition that causes inflammation in the walls of
medium-sized arteries throughout the body, including the coronary arteries,
which supply blood to the heart muscle.
Kawasaki disease is a group of specific symptoms and physical signs.
Kawasaki disease is associated with swelling and damage of the blood vessels,
or arteries. This swelling and damage is called inflammation.
Kawasaki disease often affects the arteries that supply the heart with blood.
These are called the coronary arteries.
Children who get the disease are usually less than 5 years old.
It is very rare to get the disease after a child is 10 years old.
The risk of a child getting Kawasaki disease for the second time is very rarethe second time is very rare.

8. Causes
Although the specific cause is unknown.
 it is likely to be the result of immune hyperreactivity to a
variety of triggers in a genetically susceptible host (a
polymorphism in the ITPKCITPKC genegene, a negative regulator of T-
cell activation on chromosome 19chromosome 19 is strongly associated
with susceptibility to the disease).

10. Phase 1 – Lasts 2 Weeks
104° temperature for 5
days
Red eyes
Sore throat
Swollen lymph nodes

11. SkinSkin ReactionsReactions
 Red rash on body

12. Palms of hands swell
Soles of feet swell
Red - purple in color

13. Phase 2 –Phase 2 – LastsLasts 2 Weeks2 Weeks
Skin peels from hands and
feet
Swollen painful joints
Vomiting
 Diarrhea
 Abdominal pain

14. Wrong DiagnosisWrong Diagnosis
Phase I
symptoms present
Phase II
symptoms present
Ear infection Rheumatic fever
Cold Juvenile rheumatoid arthritis
Flu Measles
Strep throat Scarlet fever
Rocky Mountain spotted fever

17. TreatmentTreatment

18. Prognosis
 With early treatment, rapid recovery from the acute symptoms can be expected,
and the risk of coronary artery aneurysms is greatly reduced.
 Untreated, the acute symptoms of Kawasaki disease are self-limited (i.e. the
patient will recover eventually), but the risk of coronary artery involvement is
much greater.
 Overall, about 2% of patients die from complications of coronary vasculitis.
 Patients who have had Kawasaki disease should have an echocardiogram
initially every few weeks, and then every one or two years to screen for
progression of cardiac involvement.

21. References
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