Pediatric emergency medicine trisk 3005 3005

FIGURE 101.11 Cracked, erythematous lips and “strawberry” tongue in Kawasaki disease.

The remaining cardinal manifestations of KD vary considerably in frequency. Up to
one-half of children with KD do not have cervical lymphadenopathy, especially
children younger than 2 years of age. When present, lymphadenopathy tends to involve
the anterior cervical nodes overlying the sternocleidomastoid muscle. Diffuse
lymphadenopathy, as well as other signs of reticuloendothelial involvement such as
splenomegaly, should prompt a search for an alternative diagnosis.
Bilateral, nonexudative conjunctivitis is present in more than 90% of patients. A
predominantly bulbar injection typically begins within days of the onset of fever, and
eyes eventually develop a brilliant erythema, which spares the limbus ( Fig. 101.10 ).
Children are also frequently photophobic, and five out of six patients have evidence of
anterior uveitis during the first week of illness. Consequently, in ambiguous cases, slitlamp examination may be helpful in confirming a diagnosis of KD.
Cracked, red lips and a strawberry tongue are characteristic of the mucositis typically
seen during the first week of KD ( Fig. 101.12 ). Discrete oral lesions, such as vesicles
or ulcers, and tonsillar exudate, are suggestive of a viral or bacterial infection rather
than KD. The cutaneous manifestations of KD are polymorphous. The rash typically
begins as perineal erythema and desquamation, followed by macular, morbilliform, or