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KAWASAKI DISEASE BY: REYNALDO B. DIAZ I extent of dense consolidation on the right lower lobe. The doctor shifted antibiotics to ceftriaxone. The patient was still on strict monitoring on the 4th day, and was still experiencing fever. On hospital day 5, she suffered sustained high grade fever and developed cherry red eyes, strawberry tongue, erythematous eyes without exudates, erythema of hands and feet with slight edema, and polymorphous rash. Echocardiography performed on the 6th day of disease revealed dilation of left ventricle with mitral regurgitation. Additionally, a dilated left anterior descending artery (maximum diameter, 3.3 mm) was observed. A diagnosis of KD was then established. She was treated with IVIG (2 g/kg) and aspirin (80 mg/kg/day). The fever eventually subsided. Causes and Symptoms: The cause of Kawasaki disease is unknown, but it apparently develops in genetically predisposed individual after exposure to an as-yet-unidentified infectious agent. After the infection, altered immune function occurs. An increase in antibody production creates circulating immune complexes that bind to the vascular endothelium and cause inflammation. The inflammation of blood vessels leads to aneurysms, platelet accumulation, and the formation of thrombi or obstruction in the heart and blood vessels. In the case of the patient, she was exposed to the causative agent of pneumonia, which then led to the development of Kawasaki disease. Diagnosis: In order to diagnose Kawasaki disease, the patient should pass the following criteria: fever of 5 or more days duration, bilateral congestion of ocular conjunctivae, changes of the mucous membrane of the upper respiratory tract, changes of the peripheral

Introduction: Kawasaki disease or Mucocutaneous Lymph Node Syndrome is a febrile, multisystem disorder that occurs almost exclusively in children before the age of puberty. Vasculitis, or the inflammation of blood vessels, is the principal and lifethreatening finding because it can lead to formation of aneurysm and myocardial infarction. Kawasaki disease is the leading cause of acquired heart disease in children. Although about 80% of patients are under five years of age, older children and teenagers can also get KD, but this is uncommon. KD is more common in boys than girls, and the majority of cases are diagnosed in the winter and early spring. It is not contagious. Patient History: A previously healthy girl of 1 year old was hospitalized due to a 3-day history of fever and cough. Breath sounds were clear without crackles, and no cardiac murmur was audible. There were no other abnormal findings on physical examination. Chest radiograph revealed increased lung markings on the right perihilar area. She was treated with antibiotics, including amoxicillin clavulanate and clarithromycin, but the fever persisted. On the second day, the patient was ordered paracetamol for the fever. She was also given tepid sponge baths during fever episodes. The patient was on strict monitoring. The doctor ordered another chest radiograph on the 3rd day, and it showed an increased

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extremities, rash, and cervical lymph node swelling. The diagnostic test for confirming Kawasaki disease is Echocardiography. This painless test uses sound waves to create pictures of the heart and coronary arteries. It can also help show the diseases effect on your childs coronary artery. Other diagnostic test may include chest x-ray, blood tests, and electrocardiogram. Here is an illustrative example of coronary artery abnormalities:

Below is the picture of the patients chest radiograph on the third day:

Below is a sample picture of the 2D Echocardiogram of a patient with Kawasaki disease:

AP VIEW Findings: Patchy consolidation on the right upper lobe and perihilar area. (initial CXR) More increased extent of dense consolidation on the right lower lobe (3rd day CXR) Dilation of left ventricle with mitral regurgitation (2D Echo) Dilated left anterior descending artery (2D Echo)

Below is the picture of the patients initial chest radiograph:

Conclusion:

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Kawasaki disease is a fatal condition that requires immediate intervention. Because the etiology is unknown, it may be best that a predisposed child must regularly attend check-ups to assure that he/she is healthy. A childs exposure to infectious microorganisms must also be attended immediately. A compromised immune system makes a child more at risk in developing Kawasaki disease. The patients condition was really alarming before she was brought to the hospital. When serious and complicated symptoms exist in ones illness, one should seek medical attention immediately to avoid further complications that might lead to more serious diseases. References: Case taken from the University of Perpetual Help DALTA Medical Center Pillitteri, A. 2010. Maternal & Child Health Nursing. Philadelphia: Lippincott Williams & Wilkins http://www.nhlbi.nih.gov/health/healthtopics/topics/kd/diagnosis.html http://cdn.intechopen.com/pdfs/26295/ InTechEchocardiography_in_kawasaki_disea se.pdf