Emergency: requires immediate attention
Kawasaki disease in Child
See also in: External and Internal Eye,Anogenital,Oral Mucosal LesionAlerts and Notices
Synopsis
- 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
- Exanthem
- Cervical lymphadenopathy (greater than 1.5 cm diameter)
A multisystem inflammatory syndrome potentially linked to COVID-19 has been reported in children and young adults; clinical features include Kawasaki-like and toxic shock syndrome-like presentations.
Adult Patient Considerations:
KD can uncommonly occur in adults. The diagnostic criteria used for pediatric patients have not yet been validated in adults, but using these criteria, both complete and incomplete forms occur in adults. It is associated with HIV infection in up to one-fifth of cases. Lymphadenopathy and joint involvement occur with a higher frequency in adults with KD than children, and cheilitis is less frequent. Cardiac complications may occur in adults including aneurysm formation; other reported cardiac complications include valvular abnormalities and heart failure. Treatment is usually delayed in adults, given delay in diagnosis, but is similar to that in children.
Codes
ICD10CM:M30.3 – Mucocutaneous lymph node syndrome [Kawasaki]
SNOMEDCT:
75053002 – Kawasaki disease
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Differential Diagnosis & Pitfalls
- Multisystem inflammatory syndrome in children (MIS-C)
- Toxic shock syndrome – Most often has focal cutaneous skin infections, abscesses, infections associated with nasal packing, or a history of recent surgical procedures.
- COVID-19
- Erythema multiforme – Presents with symmetrically distributed target lesions. Patients frequently have coexisting herpes orolabialis.
- Reactive infectious mucocutaneous eruption (RIME) – Characterized by prominent mucositis and a sparse eruption that may be polymorphous in association with underlying Mycoplasma pneumoniae or other infection.
- Viral exanthem / measles – Patients often display an exudative conjunctivitis and Koplik spots within the oral mucosa.
- Scarlet fever – 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) – A careful drug history is critical.
- Fifth disease (erythema infectiosum)
- Sexual abuse – In pediatric cases with anogenital involvement.
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Last Reviewed:08/08/2018
Last Updated:12/11/2022
Last Updated:12/11/2022
Emergency: requires immediate attention
Kawasaki disease in Child
See also in: External and Internal Eye,Anogenital,Oral Mucosal Lesion