An 8-year-old girl was admitted to the hospital with 7-day history of fever and rash. She had a diffuse macular rash, fissured lips, and strawberry tongue, and her temperature was 39°C. She had nonexudative conjunctival injection in both eyes, a few enlarged cervical lymph nodes, erythema of the palms and soles, mild edema of the hands, and periungual desquamation. 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 vasculitis of childhood. It occurs most frequently in children younger than 5 years of age and typically affects medium-sized arteries. 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.
The New England Journal of Medicine
Alakes Kole, M.D.
I.D. and B.G. Hospital, Kolkata, India and
Dalia Chandakole, M.D.B.P. Poddar Hospital Research Institute, Kolkata, India
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