Kawasaki disease

Case history

A previously healthy 1-year-old girl was admitted to a children's hospital with a 7-day history of spiking fever up to 39.5°C (103°F). Three days after the onset of fever she developed left-sided neck swelling and nappy rash, and became progressively fussy and irritable. She was seen in an emergency department, diagnosed with cervical adenitis, and sent home on oral antibiotics. The mother noted continued irritability, high fever, and decreased oral intake. On subsequent admission she was extremely irritable, with a temperature of 38.9°C (102°F), heart rate of 140 beats per minute, respiratory rate of 40 breaths per minute, and blood pressure 110/54 mmHg. There were no signs of nuchal rigidity. Both palpebral and bulbar conjunctivae were deep red and injected, lips were dry and crusted, the oropharynx hyperaemic with some areas of ulcerated mucosa, and the tongue papillae were enlarged and red (strawberry appearance). Examination of the neck revealed a mildly tender left unilateral mass, measuring 4 cm. The skin showed a generalised polymorphous, erythematous, macular, blanching rash, in addition to aseverely red and desquamated perineal region. Her extremities, especially palms and soles, were swollen, red, and mildly tender.