Monday, December 10, 2007

Also the Name of a Motorcycle

An Asian family brings their 2 year old boy into the emergency department complaining of irritability and a week long fever. They say he doesn't like to play outside anymore. On exam, you note a conjunctivitis in both eyes without exudate. His lips are chapped and erythematous. There are no ulcers or vesicles. You notice a rash on his perineum, trunk, and extremities.

Challenge: This child is at risk for serious complications. What imaging modality do you need to send him for?

Related Questions:
1. What's seen on the image?
2. This is a classic presentation of what disease?

Image shown under fair use.


Alex said...

i thought it was strawberry tongue for scarlet fever. did not know it was a type of motorcycle ?????

Craig said...

Also the Name of a Japanese Motorcycle

This is Kawasaki disease (also called mucocutaneous lymph node syndrome), a vasculitis. The incidence is highest in children living in East Asia or of Asian ancestry. Boys are more affected than girls, and most present before age 5. The symptoms described here are classic for Kawasaki (he does not play outside because of photophobia). The image shows a “strawberry tongue” due to mucositis. Although Kawasaki disease is usually self-limited, it has severe complications of coronary artery aneurysms. This child needs an echocardiogram.

Sources: UpToDate;

Craig said...

Scarlet fever (Strep pyogenes) is not a bad guess, but conjunctivitis without exudate suggests Kawasaki's.

Alex said...

and other "japanese diseases": takayasu's arteritis, hashimoto's thyroiditis, takotsubo cardiomyopathy.