Andersons pediatric cardiology 1392
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▪Retropharyngealphlegmon
▪Anterioruveitisbyslit-lampexamination
▪ErythemaandindurationatBCGinoculationsite
Thedifferentialdiagnosisincludesotherinfectiousandnoninfectious
conditions,suchasthefollowing:
▪Measles
▪Otherviralinfections(e.g.,adenovirus,enterovirus)
▪Staphylococcalandstreptococcaltoxin–mediateddiseases(e.g.,scarlet
feverandtoxicshocksyndrome)
▪Drughypersensitivityreactions,includingStevens-Johnsonsyndrome
▪Systemiconsetjuvenileidiopathicarthritis
▪Withepidemiologicriskfactors:
▪RockyMountainspottedfeverorotherrickettsialinfections
▪Leptospirosis
BCG,BacillusCalmette-Guérin;CXR,chestx-ray;KD,Kawasakidisease.
FromMcCrindleBW,RowleyAH,NewburgerJW,etal.Diagnosis,treatment
andlong-termmanagementofKawasakidisease:ascientificstatementforhealth
professionalsfromtheAmericanHeartAssociation.Circulation.
2017;135(17):e927–e999.
FIG.53.2 ClinicalmanifestationsofKawasakidisease.(A)Bulbar
nonexudativeconjunctivalinjectionwithlimbussparring.(B)Strawberry
tonguewitherythemaandprominentfungiformpapillae.(C)Diffuse
maculopapulareruption.(D)Unilateralcervicaladenopathy.(E)Plantar
swellinganderythema.(F)Palmarswellinganderythema.
Theclinicalfindingsarenonspecific,sootherdiseaseswithsimilar
presentationsshouldbeexcluded.However,thedetectionofrespiratoryviruses
shouldnotexcludethediagnosisofKawasakidiseaseinachildwithclinical
findingsofKawasakidisease.50–52Thedifferentiationbetweenadenovirus
infectionandKawasakidiseasecanbemoreconfusingowingtosimilarclinical
presentations.51,53Patientswithadenovirusinfectionsarelesslikelytohave
nonexudativepharyngitis,erythemaandswellingofthehandsandfeet,
strawberrytongue,anddesquamatinggroinrash.53,54Bacterialinfectionshave
alsobeendescribedinpatientswithKawasakidisease,mostfrequentlygroupA
streptococcaltonsillitis,pneumonia,andurinarytractinfection.55Kawasaki
diseaseshouldbeconsideredinpatientswithsomefeaturesofKawasakidisease
andnoimprovementafter24to48hoursofeffectiveantibiotictherapy.
Adiagnosisofincompletediseasemaybemadeinpatientswhodonotfulfill
theclassiccriteriaoutlinedinBox53.1,whereasthetermatypicaldiseaserefers
topatientswhohavefeaturesnotgenerallyseen,forexamplethosepresenting
withhemophagocyticsyndromeorwithrenalfailure.Becausecoronaryartery
diseasewithincompleteoratypicalfeaturesiswellrecognizedtooccurin
children,treatmentwithimmunoglobulinsmustbestartedearlytobeeffective.
Analgorithmforevaluationandtreatmentofthechildwithsuspecteddisease
hasbeendevelopedandisshowninFig.53.3.2Retrospectiveevaluationofthis
diagnosticalgorithmshowedthatitwaseffectiveinidentifyingandreferringfor
treatmentpatientswithincompleteclinicalcriteria.56,57Ahighlevelofsuspicion
isnecessaryinyounginfantswhoaremostlikelytohaveincompletecriteriaand
alsohavethehighestriskofdevelopinganeurysms.Echocardiographyis
recommendedforinfantslessthan6monthsofagewithafeverlastingfor7or
moredayswithoutotherexplanationandelevationofeitherC-reactiveproteinor
erythrocytesedimentationrate.
