This article is an answer to the Case – Fever, Rash and Tongue Changes
She had a diffuse macular rash, fissured lips, and strawberry tongue, and her temperature was 39°C. The cardiac examination was normal. A clinical diagnosis of Kawasaki’s disease was made.
Laboratory investigation revealed leukocytosis, with a white-cell count of 13,000 per cubic millimeter (reference range, 3500–10,500) and an elevated erythrocyte sedimentation rate of 80 mm per hour (reference range, 0 to 29). The platelet count and results on electrocardiography and echocardiography were normal. She was treated with aspirin and immune globulin on admission and at a follow-up visit 8 weeks later.
Kawasaki’s disease is a medium-vessel vasculitis of childhood. It occurs most frequently in children younger than 5 years of age and typically affects medium-sized arteries.
The patient may present with fever, rash, oral lesions (strawberry tongue and fissured lips), conjunctival injection, swelling of the palms and soles, and cervical lymphadenopathy. Accurate diagnosis and early therapeutic interventions can decrease the risk of coronary-artery abnormalities.
There is no diagnostic test that is specific for Kawasaki’s disease; diagnosis is based on characteristic clinical findings and the exclusion of other possibilities in the differential diagnosis, including other infectious exanthems of childhood and reactions to drugs. Aspirin and intravenous immune globulin are the typical initial therapy.
References
- Jane C. Burns, Laurel L. DeHaan, Chisato Shimizu, Emelia V. Bainto, Adriana H. Tremoulet, Daniel R. Cayan, Jennifer A. Burney. (2021) Temporal Clusters of Kawasaki Disease Cases Share Distinct Phenotypes That Suggest Response to Diverse Triggers. The Journal of Pediatrics 229, 48-53.e1.
- Mayumi Kamaguchi, Hiroaki Iwata, Takuya Asaka, Yoshimasa Kitagawa. 2021. Diseases of the Tongue. Diseases of the Oral Mucosa, 455-466.