Case (39)

[PrincessMuni]

Mariam Ali 1 yr old girl presents to the clinic with sudden, high fever that may be 104F or higher within a few days after the fever you can see red, bloodshot eyes, usually without pus or discharge and  red body rash that varies in size, shape, and consistency. The rash rarely blisters and is usually most obvious in the torso or groin area. if you check the mouth you'll see red, swollen, cracked lips and a red ("strawberry") tongue and lining of the mouth.
Firm, swollen hands and feet with shiny red palms and soles. The skin begins to shed and peel between 1 and 3 weeks after the fever starts. Peeling starts beneath the fingernails and toenails and slowly spreads to the palms and soles,  child may refuse to move or put weight on his or her hands and feet because of joint swelling and pain, abdominal pain, vomiting, and diarrhea
patient has no difficulty in breathing.
 
What is your diagnosis?
Mention one bedside test to confirm your diagnosis?
What are the complications of this condition?
How are you going to treat this patient?

[Mustafa]

Salam,

1. mucocutaneous lymph node syndrome, also called Kawasaki disease. This disease is very rare under Somalis and a higher risk among asian children. It is often seen under the age of five.
2. one of four symptoms seen at bedsite include bilateral nonexudative conjunctivitis. Others like strawberry tongue and etc.
3. major complications are a: arteritis of the coronary vessels occurring in about 25% of untreated children, on occasion causing myocardial infarction.
b: increased risk of coronary aneurysm
c: Pericardial effusions occur in 30% of cases. Myocarditis is common in the acute phase of the disease, and mitral regurgitation may be present but is usually mild. Arteritis of extremity vessels, peripheral gangrene, syndrome of inappropriate secretion of antidiuretic hormone (SIADH), and the hemophagocytic syndrome are also reported. Cerebrospinal fluid pleocytosis is reported likewise. The cause of these complications is unknown.
4. Management is with IVIG, 2 g/kg over 10 hours, with repeat dosing appearing to prevent cardiac complications. The use of plasmapheresis in up to 10% of patients who are unresponsive to immune globulin is controversial. Corticosteroids, which are also used by some in disease refractory to two or more episodes of IVIG, appear to be associated with a hastened resolution of fever and inflammatory markers and a shortened duration of hospitalization though their role in increasing the likelihood of the development of coronary aneurysms is controversial.

salam

[Dr.Abshir]

Other close differential diagnosis may be scarlet fever, but there is no conjunctivitis or swollen palms and soles.

Bedside test: there are many tests but none of them is diagnostic, I think the LP is the only one which can be done bedside.
The CSF will show us pleocytosis which is increase in white blood cells in bodily fluid like CSF.


Nice and interesting case!

[PrincessMuni]

Mustafa you got it right bro !
its kawasaki disease...
thanks for stopping by Dr. abshir