Deep Dive – Round 20

Summary: 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.

Deep Dive – Round 20

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