04.15.2021 - By Zack Olson, MD and Michael Estephan, MD
Kawasaki Disease
A small vessel vasculitis that affects children, usually <5 years old.
Symptoms – remember the CRASH AND BURN mnemonic!
Conjunctivitis
Rash – nonspecific morbilliform or maculopapular rash, usually on torso
Adenopathy – usually unilateral cervical lymphadenopathy
Strawberry Tongue – erythema, swelling, or cracking of lips/mucous membranes
Hands – swelling, erythema, or desquamation of the hands/feet
BURN – 5 days of fever
Diagnosis:
* COMPLETE KAWASAKI – 5 days of fever and 4/5 of the CRASH symptoms
* INCOMPLETE KAWASAKI – 5 days of fever and 2-3/5 of the CRASH symptoms, in the setting of elevated inflammatory markers (WBC, ESR, CRP)
Treatment: IVIG and High Dose Aspirin
Multisystem Inflammatory Syndrome in Children (MIS-C)
A new disease entity seen in children defined by widespread systemic inflammation affecting multiple organ systems that presents weeks after infection by COVID-19.
Symptoms:
* Persistent Fever* Skin involvement – nonspecific rash, conjunctivitis, changes to mucous membranes* GI involvement – nonspecific abdominal pain, nausea, vomiting, diarrhea* Renal involvement – acute kidney injury with elevated creatinine* Cardiac involvement – elevated troponin/pro-BNP, reduced EF, cardiogenic shock* Neuro involvement – altered mental status
Diagnosis and Treatment: Varies by hospital, but usually involves the presence of clinical symptoms along with a positive covid IgM/IgG, elevated inflammatory markers (WBC, ESR, CRP, Ferritin, DDimer), multisystem involvement (elevated troponin/proBNP, elevated creatinine, elevated LFTs, etc). These children need a stat ECHOcardiogram to rule out significant cardiac dysfunction.