Classical kawasaki disease

Dhivya*

Physician Assistant, Pediatric Department, Kauvery Hospital, Hosur, Tamil Nadu

*Correspondence

Abstract

Classical Kawasaki Disease is an acute systemic vasculitis affecting mainly children under five years of age. It presents with prolonged fever, conjunctivitis, oral mucosal changes, rash, extremity changes and cervical lymphadenopathy. Early diagnosis and treatment with intravenous immunoglobulin (IVIG) and aspirin are essential to prevent coronary artery complication and ensure a good prognosis.

Key words: Classical Kawasaki Disease; Intravenous immunoglobulin (IVIG)

Introduction

Kawasaki disease causes inflammation in the walls of small to medium-sized blood vessels. Kawasaki disease most often affects the coronary arteries in children.

Kawasaki disease, also known as mucocutaneous lymph node syndrome, is an illness of unknown cause that results in a prolonged fever. It is called mucocutaneous lymph node syndrome because it causes swelling in the lymph nodes and the mucous membranes inside the mouth, nose, eyes, and throat. While it does not cause permanent mental disability, it frequently causes severe irritability and fussiness in children while they are sick. Children with Kawasaki disease might have high fever, swollen hands and feet with skin peeling and red eyes and tongue. But Kawasaki disease is often treatable with early treatment, most children get better and have no long-lasting problems.

Symptoms

  • Rashes in the genital area lips, palms soles of the Feet Red eyes
  • Fever lasting at least five days
  • Irritability
  • Red on pink eyes without discharge
  • Upset Stomach
  • Swollen lymph nodes in the Neck
  • Swelling and redness of hands and feet.

Other symptoms and signs depend on which part of the body is affected;

ConjunctivitisBilateral redness of the eyes without thick, pus-like discharge.
Oral ChangesRed, dry, cracked lips and a red, swollen tongue with prominent bumps (like a strawberry).
Extremity ChangesSwelling and redness on the palms of the hands and soles of the feet, or peeling skin around the nails in later stages.
RashA polymorphic (variable) rash primarily on the trunk and genital area, which is never blister-like.
LymphadenopathyAt least one enlarged lymph node in the neck (usually measuring ≥ 1.75 cm).

Stage of Kawasaki disease

Stage 1: (Acute)

  • Fever for five days on more
  • Rash around the trunk or groin
  • Pink eye
  • Red tongue and lips
  • Red skin on hands and feet
  • Swelling in lymph node.

Stage 2: (Subacute)

  • Upset stomach
  • Diarrhea
  • Pain in Joints and belly
  • Peeling skin on hand and feet.

Stage 3: (convalescent)

Symptoms go away slowly, but complications can continue.

Test used to diagnosis

  • complete blood count (CBC)
  • C-Reactive protein (CRP)
  • Erythrocyte sedimentation rate(ESR)
  • LFT, RFT
  • Urine routine
  • B-type natriuretic peptide (BNB)
  • Echocardiogram(ECHO)

Case presentation

4 years aged’ female child came to ER with the presenting complaints of high-grade fever on and off for past five days with vomiting and loose stools with rashes and itching all over body since three days. Redness both eyes and  neck swelling since five days.

Vitals

Weight 15.4kgs
Pulse140 bpm
Spo296%
BP 90/60mmHg
Temperature104 F

On examination

  • Conscious/oriented, lethargic febrile, Bilateral non-purulent congestion (+)
  • CVS -S1, S2(+) no murmur (+)
  • RS-B/L AE (+) clear
  • P/A-soft diffuse tenderness, no hepatosplenomegaly, Bowel sounds  heard
  • CNS-NFND
  • Past Medical History-Nil
  • Immunization history- 10th year vaccinations not given
  • Developmental History-Normal
  • Allergic history- nil
  • Family History- parents have no significant history of any illness
  • N/K/C/O – thyroid / seizure.

Local examination

  • Diffuse Patchy maculopapular rashes all over body
  • Oral cavity: cracked lips (+), strawberry tongue (+), erythema of hands and feet’s (+), right posterior cervical lymph node palpable (+), non-tender
  • Pharynx: normal .

Lab investigation

DateLab investigationValues
12/04/2025Hemoglobin12.7 g/dL
Total count9600/cumm
Hematocrit39.9%
Platelet count475500/cumm
ESR71 mm/hr
CRP65.9 mg/L
SGOT45 U/L
SGPT100 IU/L
Sodium124 mmol/L
Potassium4.5 mmol/L
Urea23.2 mg/dL
Creatinine0.4 mg/dL
Typhoid Rapid IGG / IGMNegative
Urine RoutineAppearance – Turbid
Pus cell – 02 to 03 /HPF
EP cell – 02 to 04 /HPF
RBC – 03 to 05
Others – Ketone present (+)
Total count17320/cumm
Hematocrit36.6%
Platelet count401000/cumm
ESR71 mm/hr
CRP85.0 mg
SGOT44 U/L
SGPT63 U/L
Total bilirubin1.1 mg/dL
Total protein5.99/dL
Albumin serum3.29/dL
Globulin serum2.79/dL
A/G Ratio1.2 Ratio
Ferritin324.94 g/mL
Sodium137 mmol/L
15/04/2025CRP70.3 mg/L
BNP (B-type natriuretic peptide)91.7/mL
17/04/2025Hemoglobin11.6 g/dL
Total Count9300/cumm
Platelet Count588000/cumm
ESR91 mm/hr
CRP24.3 mg/L
SGOT142 U/L
SGPT159 U/L
13/04/2025USG Abdomen & Pelvis (13/04/2025)Fluid distended small and large bowel loops, Few nonspecific mesenteric lymph nodes, No e/o bowel wall thickening / inflammatory changes, No e/o free fluid noted in abdomen and pelvis, No organomegaly
14/04/2025ECHONo Regional Wall Motion Abnormality
Normal LV Function (LVEF – 66%)
Normal Valves
No pulmonary artery hypertension
RV Function good
IVC – Normal
No pericardial effusion / Clot / vegetation
No e/o coronary artery dilatation

Treatment plan

DrugDoseFrequency
Inj IV human immunoglobulin (IVig) 2g/kg (30 g)OD
Inj.Xone 750 mg IV BD
Inj.Tamin 20ml IV QID (SOS)
Inj.Rantac 10mg IV BD
Inj.Emeset 3mg IV TDS
Inj. Methylprednisolone 15mg IV BD
Tab. Aspirin 325mg BD
Tab.Limcee ½
Syp.Atarax 5ml TDS
Syp.Combiflora 5ml BD
Syp.Azee 4ml (200/5) HS
Syp.Meftal P 6ml (SOS)
Syp.Carnisurge 5ml BD
Econorm sachet BD
Zytee gel L/A
Calamine lotion L/A

Advice of medication

DrugDoseFrequency
Tab. Fadox100mg 1/2-0-1/2 × 3 days
Tab. Aspirin 75mg OD × to continue
Tab. Junior Lanzol (b/f) 15mg OD × 3 days
Syp. Emeset (b/f) 5ml BD× 3 days
Syp. Becosules 5ml OD × 14 days
TB.Aspirin 75mg OD x 6 weeks

Review

After 3 days’ patient came to OPD for review; patient symptomatically better, vitals were normal, rashes decreased.

Prevention

  • Maintain good personal hygiene and regular handwashing.
  • Avoid close contact with sick people.
  • Ensure children receive routine vaccinations on time.
  • Provide a balanced diet and adequate rest.
  • Seek medical attention if fever lasts more than 5 days.
  • Early diagnosis and treatment prevent serious complications.
  • IVIG and aspirin therapy help reduce heart damage and inflammation.
  • Regular echocardiography and follow-up are important to monitor the heart.

Conclusion

Kawasaki disease is an acute inflammatory illness that mainly affects children under 5 years of age. Although its exact cause is unknown, early diagnosis and prompt treatment with IVIG and aspirin can reduce serious heart complications. With proper medical care and follow-up, most children recover completely and lead healthy lives

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