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Kawasaki Disease

A small vessel vasculitis that affects children, usually <5 years old.

Symptoms – remember the CRASH AND BURN mnemonic!

Conjunctivitis

Rash – nonspecific morbilliform or maculopapular rash, usually on torso

Adenopathy – usually unilateral cervical lymphadenopathy

Strawberry Tongue – erythema, swelling, or cracking of lips/mucous membranes

Hands – swelling, erythema, or desquamation of the hands/feet

BURN – 5 days of fever

Diagnosis:

  • COMPLETE KAWASAKI – 5 days of fever and 4/5 of the CRASH symptoms
  • INCOMPLETE KAWASAKI – 5 days of fever and 2-3/5 of the CRASH symptoms, in the setting of elevated inflammatory markers (WBC, ESR, CRP)

Treatment: IVIG and High Dose Aspirin

Multisystem Inflammatory Syndrome in Children (MIS-C)

A new disease entity seen in children defined by widespread systemic inflammation affecting multiple organ systems that presents weeks after infection by COVID-19.

Symptoms:

  • Persistent Fever
  • Skin involvement – nonspecific rash, conjunctivitis, changes to mucous membranes
  • GI involvement – nonspecific abdominal pain, nausea, vomiting, diarrhea
  • Renal involvement – acute kidney injury with elevated creatinine
  • Cardiac involvement – elevated troponin/pro-BNP, reduced EF, cardiogenic shock
  • Neuro involvement – altered mental status

Diagnosis and Treatment: Varies by hospital, but usually involves the presence of clinical symptoms along with a positive covid IgM/IgG, elevated inflammatory markers (WBC, ESR, CRP, Ferritin, DDimer), multisystem involvement (elevated troponin/proBNP, elevated creatinine, elevated LFTs, etc). These children need a stat ECHOcardiogram to rule out significant cardiac dysfunction.