A 3 Year Old Boy With Fever And Rash

A concerned mother brings in her 3 year old child with a history of fever for 1 week. She said initially she thought the fever would resolve but the child is getting sicker and she is now worried. The patient along with fever has developed a diffuse body rash, has decreased appetite and is lethargic. On examination , the child looked sick, has a temperature of 103 F and a diffuse, erythematous macular rash with peeling of skin on the finger tips. The tongue was bright red in color and cervical lymph nodes were enlarged and tender.

A few Picture taken in the clinic are shown below:

Bright red tongue with white papillae.

                    Skin Peeling at Finger tips.

What is the Differential Diagnosis?

• Rheumatic fever
• Kawasaki disease
• Scarlet fever
• Cervical lymphadenitis.
• Parvovirus B19 infection.
• Drug hypersensitivity reaction.

The Final Diagnosis in the above case was Kawasaki Syndrome.

Kawasaki syndrome is an acute vasculitis of unknown etiology which is most often seen in children. Kawasaki syndrome presents with at least 5 days of fever, polymorphous rash, conjunctival

injection, mucous membrane involvement (e.g., “strawberry” tongue), cervical lymphadenopathy,

and extremity findings of erythema and desquamation.

Management: The usual treatment is aspirin and IVIG. Steroid therapy is controversial and does not seem to improve outcomes. There may be cardiac involvement with the formation of coronary artery aneurysms.