Child with fever and a rash.

Abstract

A previously healthy 9-month-old Asian male presented to the emergency department with 3 days of fever and rash. The rash had begun on his buttocks, then spread to his trunk and extremities (Figures 1 and 2). His mother noted his hands and feet appeared red and swollen over the previous 2 days (Figure 3), and that his tongue appeared unusually red with some fine vesicles and cracking of his upper lip (Figure 4). Cervical lymphadenopathy was noted on physical examination. Laboratory results included a serum white blood cell count of 18,400/mm3, an elevated C-reactive protein and erythrocyte sedimentation rate of 71 mg/dL and 63 mm/h respectively, and urinalysis with 58 WBCs/hpf. Kawasaki disease is an acute systemic vasculitis with a predilection for the coronary arteries that most commonly affects children of Asian or Pacific Islander descent that are <5 years old.1-3 Kawasaki disease is a clinical diagnosis based on the presence of fever for 5 days combined with at least 4 of the following features: oral changes including strawberry tongue or erythema and cracking of the lips, bilateral conjunctival injection, a maculopapular or erythema multiforme-like rash, erythema and edema of the hands and feet, and cervical lymphadenopathy.4 As with this case, Kawasaki disease may be diagnosed with fever duration of less than 5 days if other classic clinical findings are present, including an elevated serum white blood cell count, elevated inflammatory markers, and evidence of sterile pyuria.4