February 1, 2025

A 2-year-old boy has been ill with fever for almost 1 week

By Med-Challenger · 2 minute read

A 2-year-old boy is brought in by his parents, who are concerned that he has been ill with fever for almost 1 week. They report that he had some fussiness and runny nose 1 week ago followed by fever to 101.5°F intermittently for the last 5 days. He has had no household ill contacts, and he has not had any diarrhea or emesis.

At the time of examination, he has temperature of 38.3°C and mild tachycardia. He is not lethargic. Eyes have conjunctival injection, particularly at the periphery, but there is no conjunctival discharge. He has anterior tender cervical lymphadenopathy. His lips are red and cracked, and his tongue is erythematous and slightly enlarged. He has tonsillar adenopathy without exudate. His tongue and lips are shown in the Figure.

image (73) Figure.

Of the following, which therapy is most likely to benefit this child?

oral penicillin VK 50 mg/kg/day
oral prednisone 1 mg/kg
intravenous immunoglobulin (IVIG) and aspirin
acetaminophen scheduled every 4 hours

The correct answer is:

intravenous immunoglobulin (IVIG) and aspirin

Educational Objective:

Recognize the manifestations of and treat Kawasaki disease.

Key Point:

Kawasaki disease is a vasculitis with an unclear cause that is diagnosed based on clinical symptoms and is treated with IVIG and aspirin, with the goal of preventing coronary artery aneurysms or thrombosis.

Explanation:

This child has Kawasaki disease, a vasculitis of medium-sized arteries that is associated with coronary artery–related complications, including aneurysms and thrombosis. The diagnosis is clinical, based on febrile children having a combination of the following:

Nonexudative conjunctival injection with limbal sparing
Tongue and lip erythema and pharyngeal erythema
Cervical lymphadenopathy
Swelling and/or rash of the extremities
Polymorphous rash

Laboratory findings are nonspecific and often include leukocytosis, thrombocytosis, and elevated inflammatory markers. Treatment is with IVIG and aspirin.

Steroids have not been found to be helpful in most cases. The fever of Kawasaki disease is often unresponsive to acetaminophen. Penicillin would not be helpful in the absence of bacterial infection.

References:

McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation. 2017;135:e927.

Son MB, Newburger J. Kawasaki disease (chapter 166). In: Kliegman RM, et al. Nelson Textbook of Pediatrics. 20th ed., 2016:1209-1214.

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