Kawasaki disease: Clinical

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Kawasaki disease: Clinical

USMLE® Step 2 questions

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USMLE® Step 2 style questions USMLE

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A 4-year-old Asian boy comes to the emergency department because of a fever for the past six days. His temperature is 39.4°C (102.9°F), pulse is 100/min, respirations are 20/min, and blood pressure is 90/60 mm Hg. Physical examination shows bilateral conjunctivitis, maculopapular rash, pedal edema, and cervical lymphadenopathy. A complete blood count shows:

Which of the following is the most appropriate treatment?


Kawasaki disease is a vasculitic disease in which medium-sized arteries throughout the body become inflamed.

It typically affects young children from 1 to 5 years old, but can sometimes affect teenagers and even adults.

It is usually a self-limited condition, with fever and manifestations of acute inflammation for at least five days, lasting for an average of 12 days without therapy, and it’s not very responsive to treatment with paracetamol or ibuprofen.

The most frequent and characteristic signs and symptoms, included in the diagnostic criteria, can be remembered with the mnemonic CRASH.

First off, they may typically present with bilateral bulbar Conjunctival injection, which typically begins within days of the onset of fever, and leads to photophobia or discomfort or pain to the eyes due to light exposure.

Then there’s polymorphous Rash that usually begins during the first few days of illness due to sensitivity to sunlight.

A stands for lymphadenopathy, which tends to primarily involve the anterior cervical nodes overlying the sternocleidomastoid muscles.

Next up, there are oral mucous membrane changes, including injected or fissured lips, injected pharynx, or Strawberry tongue.

And finally, there are peripheral extremity changes, including erythema of palms or soles, edema of Hands or feet, and periungual desquamation.

To make a diagnosis of Kawasaki, individuals must meet at least four of these features. Other common features include irritability, rhinorrhea, cough, vomiting, diarrhea, abdominal pain, and joint pain.

A severe complication of Kawasaki disease is cardiovascular disease, which most commonly presents as coronary artery aneurysms, and can lead to arrhythmias, myocardial infarction, and ultimately, heart failure.

Typically, an ECG and echocardiography are done in individuals with Kawasaki to look for cardiovascular involvement.


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