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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. 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

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  1. KAWASAKI DISEASE Carreon G., Carreon J., Casaul J.R., Coronado M.C., Corpuz D., Credo C., Danguilan M.C., De Gracia C.

  2. AIM: • Review the clinical presentations of Kawasaki disease, its progression, serious complications and management. • Discuss the D/Dx of Kawasaki disease.

  3. S> • 14 m/o, M, from Antipolo City, Filipino, Catholic, born on May 21, 2010 • 1st admission at this institution (May 24, 2011)

  4. CC: • Request for transfer of service, T/C Kawasaki Disease

  5. 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. 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

  7. 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. 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

  9. 2nd DOI (4 days PTA) – 5/20/11 • MEDs: • Paracetamol drops, 12 mkdose • Cefuroxime, 105 mkd, 350 mg IV, q8h • Budesoniode • Salbutamol

  10. 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

  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

  12. 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

  13. 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

  14. 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

  15. Primary Impression • Kawasaki disease

  16. 5th DOI (1 day PTA) – 5/23/11 • Sx persisted • (+) stawberry tongue • MEDs: same

  17. 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

  18. 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

  19. 6th DOI (DOA) – 5/24/11 • LABs: • CBC • Re-reading of CXR (wet read) • Pneumonia LU and both LLF • Mild pulmonary hyperinflation

  20. 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)

  21. 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

  22. 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

  23. 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

  24. 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

  25. 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

  26. 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

  27. 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

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