A. Await repeat throat culture to determine therapy
B. Empiric penicillin for streptococcal coverage
C. Empiric vancomycin for staphylococcal and streptococcal coverage
D. Intravenous immunoglobulin
E. Oral corticosteroids
Answer: D. Intravenous immunoglobulin
Discussion: Kawasaki's disease is the most common cause of acquired heart disease in children in the United States. Diagnosis is based on clinical findings and this disease should be suspected in children who have a fever for 5 days or longer.
Four of the following findings along with fever support the diagnosis of Kawasaki's disease:
- strawberry tongue,
- oropharyngeal erythema, and
- digital desquamation.
The primary concern with Kawasaki's is prevention and detection of cardiac complications, which develop in more than 50% of patients.
- Myocarditis occurs most commonly—in up to one-half of patients.
- Coronary aneurysms, which are associated with coronary thrombosis or rupture, and
- myocardial infarction develop in an additional 20% of patients.
Prompt therapy with intravenous immunoglobulin and aspirin lessen the risk for developing these cardiac complications.
Included in the differential diagnosis for Kawasaki's disease are
- scarlet fever,
- toxic shock syndrome,
- drug reactions,
- Stevens-Johnson syndrome, and
- juvenile rheumatoid arthritis.