top of page

PUID: 51 || PLAB 2 Mock 6 :: FeverishChild11: Kawasaki Disease

Summary:

This scenario involves a 3-year-old child presenting to a GP setting with persistent high-grade fever, a polymorphous rash, conjunctivitis, and cervical lymphadenopathy. The case focuses on diagnosing Kawasaki Disease, a medical emergency due to its potential cardiovascular complications, particularly coronary artery aneurysms.



Key Points:


Clinical Features

  • Fever: Persistent, high-grade, risk of febrile convulsions in young children.

  • Rash: Polymorphous (varied shapes and sizes), not typically itchy or painful.

  • Conjunctivitis: Non-purulent.

  • Oral changes: Strawberry tongue, cracked lips.

  • Lymphadenopathy: Unilateral cervical (distinguishes from other causes like scarlet fever).

  • Extremity changes: Swelling and desquamation (peeling) of palms and soles.


Differential Diagnosis Considerations

  • Scarlet fever: Strawberry tongue and sandpaper rash, but bilateral lymphadenopathy.

  • Measles: Maculopapular rash with conjunctivitis.

  • Infectious mononucleosis: May mimic but typically has bilateral lymphadenopathy.

  • Meningococcal infection: Ask about neck stiffness and photophobia due to potential non-blanching rash.


Important Considerations:

  • Kawasaki Disease is a medical emergency.

  • Early treatment is crucial to prevent coronary artery aneurysms.

  • Children on aspirin therapy should not receive the flu vaccine due to risk of Reye’s Syndrome.

  • Assess immunization history and defer flu vaccination if due soon.

  • Recognize the setting (GP clinic) and refer for hospital admission — do not attempt treatment in the GP setting.


Diagnostic Approach:

  1. History:

    • Duration and pattern of fever.

    • Rash details: onset, nature, progression.

    • Red eye symptoms: discharge, photophobia.

    • Associated symptoms: feeding/drinking, irritability, lymphadenopathy.

    • Medication and vaccination history.

    • Exposure history (infections, chickenpox misconception).

  2. Examination:

    • Vitals and general physical examination.

    • Lymph nodes, rash inspection, oral cavity.

    • Cardiac examination and signs of dehydration or systemic involvement.

  3. Investigations (hospital):

    • Bloods: CRP, ESR, CBC, liver function.

    • Echocardiography to assess coronary artery involvement.


Management:

  • Immediate referral to A&E for hospital admission.

  • Pharmacological:

    • IV Immunoglobulin (IVIG).

    • High-dose aspirin (antipyretic and anti-inflammatory).

  • Supportive:

    • Paracetamol for fever.

    • Adequate hydration and monitoring.

  • Follow-up:

    • Cardiology follow-up with repeat echocardiograms.

  • Patient Education:

    • Provide leaflets about Kawasaki Disease.

    • Safety netting for signs like worsening fever, irritability, breathing difficulty.


Communication Skills:

  • Acknowledge parent's concern and validate fears.

  • Use simple, non-medical language.

  • Explain that the diagnosis is likely and requires confirmation.

  • Emphasize treatability and the urgency of hospital treatment.

  • Safety net and summarize next steps effectively.

  • Use structured communication and signpost each part of the conversation.


Ethical Considerations:

  • Informed consent for referral and treatments.

  • Confidentiality maintained throughout.

  • Respect parental autonomy and explain rationale for medical decisions, including vaccine deferral.


Additional Resources:

  • NICE Clinical Knowledge Summary: Kawasaki Disease

  • RCPCH Guidelines on management of paediatric inflammatory conditions

  • GMC's "Good Medical Practice" (2024) guidelines

  • Examiner tips on structured consultations and avoiding stock phrases

Comments

bottom of page