A 4-year-old boy is brought in by his parents for evaluation of a fever that has persisted for the past 5 days. He has also been more irritable than usual and had 2 or 3 episodes of vomiting. The patient has no prior medical problems and takes no medications. He has received all recommended vaccinations. He traveled to China last year to visit his grandparents and cousins but has not traveled outside of the country this year. Temperature is 38.9 C (102 F). Physical examination shows bilateral conjunctival injection with no exudates. His tongue is bright red and lips are cracked. Nonpitting edema is present on his hands and feet. Which of the following complications is this patient at greatest risk for developing?

Question

A 4-year-old boy is brought in by his parents for evaluation of a fever that has persisted for the past 5 days.  He has also been more irritable than usual and had 2 or 3 episodes of vomiting.  The patient has no prior medical problems and takes no medications.  He has received all recommended vaccinations.  He traveled to China last year to visit his grandparents and cousins but has not traveled outside of the country this year.  Temperature is 38.9 C (102 F).  Physical examination shows bilateral conjunctival injection with no exudates.  His tongue is bright red and lips are cracked.  Nonpitting edema is present on his hands and feet.  Which of the following complications is this patient at greatest risk for developing?

Quizplus · Accepted Answer

11ec160b_38d3_83ef_9249_67515ce1ceb4_MD0001_00 Kawasaki disease is a vasculitis of medium-sized arteries that affects young children (usually age <5 years). It occurs most commonly in patients of Asian ethnicity. The diagnosis of Kawasaki disease is based on a fever for >5 days plus 4 of the following findings: A serious complication of Kawasaki disease is coronary artery inflammation leading to the development of coronary artery aneurysms. (Choice A) Dissecting aneurysms of the aorta are associated with long-standing hypertension and Marfan syndrome. (Choice C) Monocular blindness is a complication of temporal arteritis. (Choice D) Mononeuritis multiplex is a peripheral neuropathy of multiple individual nerves. It is associated with a variety of diseases, including granulomatosis with polyangiitis (Wegener's) and polyarteritis nodosa. (Choice E) Acute proliferative glomerulonephritis can occur after group A streptococcal skin/throat infections. Although symptoms such as fever, "strawberry" tongue, and desquamation can occur in scarlet fever, this patient's bilateral nonexudative conjunctivitis, swelling of the hands and feet, and persistent high-grade fever are more suggestive of Kawasaki disease. (Choice F) Pulmonary cavities can occur following resolution of pulmonary tuberculosis, histoplasmosis, or sarcoidosis. Educational objective: Kawasaki disease is a vasculitis of medium-sized arteries that presents with persistent fever for >5 days, bilateral conjunctivitis, cervical lymphadenopathy, and mucocutaneous involvement. Coronary artery aneurysms are a serious complication of Kawasaki disease. __________ References: Coronary artery dilation in acute Kawasaki disease and acute illnesses associated with Fever. (http://www.ncbi.nlm.nih.gov/pubmed/22673140) Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. (http://www.ncbi.nlm.nih.gov/pubmed/15574639)

A 4-Year-Old Boy Is Brought in by His Parents for Evaluation