Kawasaki disease in Infant/Neonate
The classic case definition of KD is:
- Fever lasting at least 5 days
- Bilateral bulbar conjunctival injection without exudate
- Oral mucosa changes: cracked lips, "strawberry tongue," or diffuse erythema of the mucosae
- Changes in the extremities: erythema, induration, or periungual peeling
- Cervical lymphadenopathy (greater than 1.5 cm diameter)
M30.3 – Mucocutaneous lymph node syndrome [Kawasaki]
75053002 – Kawasaki disease
- Common pitfalls may include diagnosing an infection in an infant with fever and an enlarged cervical lymph node (bacterial lymphadenitis) or sterile pyuria (partially treated urinary tract infection). The subsequent exanthem and mucosal changes may be misdiagnosed as a drug reaction to the prescribed antibiotics. Viral meningitis may be misdiagnosed in an infant with fever, rash, and cerebrospinal fluid pleocytosis.
- Patients with toxic shock syndrome most often have focal cutaneous skin infections, abscesses, infections associated with nasal packing, or a history of recent surgical procedures.
- Erythema multiforme presents with symmetrically distributed target lesions. Patients frequently have coexisting herpes orolabialis.
- Viral exanthems like measles may be difficult to distinguish from Kawasaki disease. However, patients with measles often display an exudative conjunctivitis and Koplik spots within the oral mucosa.
- The cutaneous and mucosal findings in scarlet fever may also easily be confused with Kawasaki disease. However, these patients respond to anti-streptococcal antibiotic therapy.
- Staphylococcal scalded skin syndrome presents with erythema and desquamation accentuated within skin folds.
- Distinguishing drug reactions (eg, Stevens-Johnson syndrome) from Kawasaki disease can be difficult. A careful drug history is critical.
- Kawasaki disease can present with red cheeks, as does fifth disease (erythema infectiosum). Premature closure on fifth disease leading to missing Kawasaki disease is a diagnostic pitfall.
- Behçet syndrome
- Contact dermatitis
- Seborrheic dermatitis
- Sexual abuse