A three-year-old boy presented with a seven-day history of fever. He had a polymorphous rash and bilateral conjunctival infection. On examination he had cervical lymphadenopathy (about 1.5 cm in diameter), red and cracked lips as well as a red throat. He was apyrexial and the skin of his palms and soles was starting to peel. What is the diagnosis, management and differential diagnoses?
DIAGNOSIS AND MANAGEMENT
The diagnosis is Kawasaki disease. It may take six to eight weeks for the symptoms to resolve. The joints may also be inflamed, especially larger weight-bearing joints. Treatment is most effective if given in the first 10 days of the disease to prevent some coronary damage. Aspirin is used to decrease inflammation and lower fever, as well as to prevent blood clots. Although some children recover without treatment, 15-25 per cent have coronary artery damage. The boy was referred to the paediatrician.
POSSIBLE DIFFERENTIAL DIAGNOSES
- Scarlet fever.
- Erythema multiforme.
- Stevens-Johnson syndrome.
- Erythema infectiosum.
- Tonsillitis or pharyngitis.
- Diffuse erythematous rash on trunk.
- Sore tongue.
- Circumoral pallor.