A 4-Year-Old Girl With Persistent Fever and Rash: Osmosis USMLE Study Question

August 06, 2021

This patient meets the diagnostic criteria for Kawasaki disease. The diagnosis is based on at least 5 days of fever plus 4 out of 5 criteria. The 5 criteria include nonexudative conjunctivitis, rash, lymphadenopathy, oral changes including redness of the mucosa, peeling lips or "strawberry tongue," and swelling, erythema or desquamation of the extremities. A convenient mnemonic is listed below.

CRASH and Burn

  • Conjunctivitis: nonexudative, bilateral injection (>90%)

  • Rash: anything, but not vesicular and not bulla (>90%)

  • Adenopathy: >1.5cm. typically cervical and unilateral (<50%)

  • Strawberry tongue: Redness of oral mucosa or lips or dry peeling lips (>90%)

  • Hand: Swelling or erythema of hands that progresses to peeling (>90%)

  • and Burn: 5 days of daily fevers

The most feared complication is coronary artery aneurysm. Treatment consists of intravenous immunoglobulins (IVIG) and high-dose aspirin therapy.

Major Takeaway: Kawasaki disease is an acute, febrile, vasculitic syndrome that classically affects children under the age of five, causing redness of the mouth and eyes, peeling lips or "strawberry tongue," and swelling, erythema or desquamation of the extremities. Treatment of Kawasaki disease requires aspirin and intravenous immunoglobulins.

Read more on Kawasaki disease.

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