COMMENTARY

Eye Redness and Rash -- Could It Be Kawasaki?

Christopher J. Chiu, MD; Justin Berk, MD

Disclosures

February 19, 2021

This transcript has been edited for clarity.

Christopher J. Chiu, MD: Welcome back. We are The Cribsiders, the pediatric medicine podcast that interviews leading experts in the field to bring you clinical pearls and practice-changing knowledge, and answer lingering questions about core topics in pediatric medicine.

Justin L. Berk, MD, MPH, MBA: We're summarizing our podcast episode on Kawasaki disease with Dr Adriana Tremoulet, assistant director of the Kawasaki Disease Research Center at the University of California, San Diego. She also did our MIS-C episode earlier on.

Dr Tremoulet gave us an overview of the criteria for Kawasaki disease. One of the major features of Kawasaki disease is eye redness. It is not a conjunctivitis because it's not actually swelling, but it's an eye redness that's limbic sparing, so it saves the whites of the eyes. Next, we have the nonspecific rash which includes pretty much anything except a vesicular rash. Other features includes edema of the hands and feet, cervical lymphadenopathy that's usually unilateral, and changes in the lips and oral cavity with a strawberry tongue.

We also talked about important clinical findings of Kawasaki disease. Often kids can present with just a limp, and it can be an arthritis or another sign of the inflammation throughout the body from Kawasaki. A peeling rash around the toenails and fingernails is a very common finding in late-stage Kawasaki disease.

Chiu: Something to keep in mind is that if you have incomplete Kawasaki disease, meaning only two to three of the five things that you need for Kawasaki plus a fever, you really need to do more of a lab workup. This includes a bunch of the biomarkers, which measure the inflammation associated with a higher risk for coronary artery aneurysm. These biomarkers include ESR, CRP, white count, albumin, ALT, and GGT. These lab tests will help us through that whole workup.

Berk: I think these are great risk factors for coronary artery aneurysms. Some of the other risk factors that she mentioned include age younger than 6 months and any laboratory test extremes. When you start seeing a high platelet count in the millions, that can be a pretty bad sign. Another sign of an increased risk for coronary artery aneurysm is an early rise in an inflammatory marker.

Chiu: Another big takeaway that we talked about in this episode is what if people fail that first intravenous immunoglobulin (IVIg) course with steroids? Second-line therapy options include repeating IVIg, steroids, anakinra, or infliximab. Also, another thing we talked about is getting transesophageal echocardiography (TTE) 1-2 weeks after discharge.

Berk: It was a great episode. We go into more detail about some of the demographics of Kawasaki disease. It’s definitely worth checking out on any podcast app. You can hear the full podcast and see images of the typical clinical findings here: #16: Kawasaki Disease with Recrudescent Guest Dr. Tremoulet

Dr Berk is assistant professor of medicine and pediatrics at the Warren Alpert School of Medicine at Brown University. He is a clinical educator active in ambulatory and inpatient patient care on medicine and pediatrics. He enjoys coffee, thinking about hiking, and being a generalist. Follow him on Twitter

Dr Chiu is assistant professor at The Ohio State University where he is also the physician lead at OSU's Outpatient Care East Clinic and serves as the assistant clinical director for the internal medicine residency. He is an Air Force veteran and a self-proclaimed gadget geek. Follow him on Twitter

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