A 10-year-old child has a 1-week history of fever of 104°C that is unresponsive to antipyretics. The primary care pediatric nurse practitioner examines the child and notes bilateral conjunctival injection and a polymorphous exanthema, with no other symptoms. Lab tests show elevated ESR, CRP, and platelets. Cultures are all negative. What will the nurse practitioner do?

Question

Quizplus · Accepted Answer

The child presents with symptoms consistent with Kawasaki disease, including fever, conjunctival injection, polymorphous exanthema, and elevated inflammatory markers. Although there is no definitive diagnostic test for Kawasaki disease, the presence of fever for more than 5 days along with at least 4 of the following criteria (conjunctival injection, polymorphous exanthema, cervical lymphadenopathy, mucous membrane changes, or peripheral extremity changes) is highly suggestive. The nurse practitioner should order a baseline echocardiogram to assess for the potential complication of coronary artery aneurysms, which can develop in up to 25% of untreated cases. Repeat echocardiography in 2 weeks may be necessary if the initial echocardiogram is normal but clinical suspicion for Kawasaki disease remains high. Intravenous methyl prednisone is not typically used in the treatment of Kawasaki disease, and IVIG therapy is typically initiated sooner if Kawasaki disease is suspected. Reassurance is not appropriate given that Kawasaki disease can have serious complications if left untreated.

A 10-Year-Old Child Has a 1-Week History of Fever of 104°C