Pediatric emergency medicine trisk 3008 3008

TABLE 101.17
DIFFERENTIAL DIAGNOSIS OF KAWASAKI DISEASE

KD is most commonly confused with exanthematous infections of childhood ( Table
101.17 ). Measles, echovirus, and adenovirus may share many of the signs of
mucocutaneous inflammation, but they typically have less evidence of systemic
inflammation, and generally lack the extremity changes seen in KD. Toxin-mediated
illnesses, especially β-hemolytic streptococcal infection and toxic shock syndrome,
generally lack the ocular and articular involvement typical of KD. Finally, drug
reactions such as Stevens–Johnson syndrome or serum sickness may mimic KD but
with subtle differences in the ocular and mucosal manifestations.
Triage Considerations
Young children with prolonged fever, especially in the setting of irritability or
fussiness, in association with one or more of the following cardinal signs,
conjunctivitis, rash, mucosal inflammation, cervical lymphadenopathy, or extremity
changes, should lead to prompt evaluation for KD. The most serious complications of
KD are cardiac and the major complication is coronary artery aneurysms. Infants
younger than 1 year of age have the highest risk of developing coronary artery
aneurysms. A rare but potentially life-threatening complication is Kawasaki shock
syndrome. It is defined as systolic hypotension for age, a sustained decrease in systolic
blood pressure from baseline of ≥20%, or clinical signs of poor perfusion.
Clinical Assessment
The conventional diagnostic criteria are particularly useful in preventing overdiagnosis,
but they may result in failure to recognize incomplete forms of the illness. It should be
emphasized that children who do not fulfill formal diagnostic criteria are still at risk of