Case Study: Management of Kawasaki Disease in a Pediatric Patient

Vishnu

Deputy Nursing Superintendent, Kauvery Hospital, Hosur

Abstract:

Kawasaki disease, also known as mucocutaneous lymph node syndrome, is a condition which primarily affects children and involves inflammation of the blood vessels systemically. It is characterized by a high-grade fever lasting more than five days, along with symptoms such as rashes, swelling of the hands and feet, redness in the eyes, swollen lymph nodes, and irritation and inflammation of the mouth, lips, and throat. Though exact cause is unknown, it is believed to result from an abnormal immune response to an infection. Early diagnosis and treatment are crucial to prevent serious complications, such as coronary aneurysms.

Case Presentation:

On a typical day, I completed my work and returned home. My wife’s friend contacted me to tell me that her four-year-old daughter has had a fever for the past two to three days. I casually recommended that she go to the hospital; just visit the pediatrician once on an outpatient basis and they would prescribe medication. They at once rushed to the hospital’s Emergency Department for consultation. On the visit, the child had a high temperature of 104ŸF and oedema in the neck region. The pediatrician informed that the child had unilateral parotitis, as well as a fever, for which antibiotics were administered for three days.

Ibugeric plain 7.5ml0 - 7.5ml X 3 days
Rantac 3.5ml0- 3.5ml X 3 days
Advent 4ml0 - 4ml X 3 days
Zincovit 5ml OD5ml X 14 days

On April 12th, at about 15:30, they returned to the ER with the same complaints of high fever on and off for four days, four episodes of vomiting and two episodes of loose stools, rashes and itching all over the body, and loss of appetite. The child had maculopapular rash. The pediatrician began fever treatment with a Mumps query and recommended ward admission to monitor the child with the medications. A blood sample was given to the lab and recommended an Echo.

IV Fluids 50ml/hr
Inj. Tamin 20ml - IV 6th Hourly
Syp. Meftal-P 6ml (SOS)
Inj. Xone 750mg
Syp. Atarax 5ml TDS
Calamine Lotion
Inj. Rantac 20mg IV (1-0-1)
Inj. Emeset 2 mg IV (TDS)
Syp. Combiflora 5ml

After receiving the child from the ER department, vitals were checked and recorded. Inj. Xone given and applied calamine lotion for itching. Temperature dropped to 102.4o F, Syp. Meftal given. Lab reports arrived as Na+ 124, immediately informed the pediatrician, advised for sodium correction plain NS Bolus 150ml. The pediatrician visited the child and advised syrup Azee; there were no fever spikes. At around 12am, the child had a fever of 100oF, Inj. Tamin was given, but the fever did not settle. Again at 2.30am temperature rose to 102.5oF, tepid sponge given. Also had two episodes of loose stools, informed the pediatrician, and was advised Econorm sachet BD. Child had disturbed sleep all night. Around 6.30am, child had continuous cry due to itching, Inj. Avil 3mg dose given and planned for the Ultrasound Abdomen and Pelvis; and Echo.

At 21:00, the child’s temperature was 100.8oF and mouth ulcer present for which zytee gel was applied and started on Inj. Dexamethasone 4 mg, IV fluids 50ml/hr. At 14.30 child was oriented and vitals checked, had of fever 100.4oF, immediately Inj. Tamin given. After one hour, fever settled, tepid sponge given. Throughout the day, child had fever spikes intermittently. Later IV line was infiltrated, hence removed and new IV line secured, and the Pediatrician recommended investigations CBC, CRP, LFT, Na+, Ferritin done. The child had prolonged fever (five days or more) accompanied by at least four of the following symptoms: rash, swollen lymph nodes, red eyes (conjunctivitis), red and dry cracked lips, swollen tongue, and swollen red hands, Classical Kawasaki.

Child had high grade fever spike 100.3ŸF, not co-operative for the vitals checking and medications. As per pediatrician’s order medications were continued, again nighttime child’s temperature was 100.5ŸF, Inj. Tamin given. Fever settled at nighttime, IV line was infiltrated, so removed the line and new line was inserted in the right leg. Pediatrician recommended IV fluids 25 ml/hr and Inj. Immunoglobulin transfusion for the child was given, no reaction noted. Once again, the same cycle of feverish temperature, IV fluids and IV-line infiltration occurred. Child was encouraged for oral intake. Fever, cough, and abdomen pain gradually reduced and had no fever. Finally, the child was discharged in a stable condition without any fever, abdomen pain, cough, and strawberry tongue.

Conclusion:

Kawasaki disease is rare and treated for the first time in our hospital. A nurse’s role is crucial in early recognition and collaborative care. Early and effective treatment significantly reduces the risk of coronary artery complications and improves the overall prognosis for the affected child. With these measures, most children with Kawasaki disease recover fully without long-term issues.

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