2025 – PAGE 137 – CARDIOLOGY

KAWASAKI DISEASE, AKA MUCOCUTANEOUS LYMPH NODE SYNDROME

DIAGNOSTIC CRITERIA FOR KAWASAKI DISEASE

Make sure you keep Kawasaki disease in your differential for any young patient who has been febrile for more than 5 days! Eighty-five to 90% of affected children are younger than 5 years. Diagnostic criteria for Kawasaki Disease include 5 days of fever PLUS 4 out of 5 other findings, including:

• Erythema of the hands/feet
• A non-exudative conjunctivitis
• A non-vesicular rash
• Mucosal involvement (lips, oral mucosa, or “strawberry tongue”)
• Lymphadenopathy

MNEMONIC = “THERMA/L, THERMaL or THERMAl”:

• Temp for 5 days
• Hand findings (erythema of hands/feet)
• Eye findings (non-exudative conjunctivitis)
• Rash (non-vesicular)
• Mucosal involvement (oral mucosa, lips, strawberry tongue)
• Adenopathy or Lymphadenopathy

SUPPORTIVE DATA

Anemia, elevated ESR, leukocytosis, and thrombocytosis support the diagnosis of Kawasaki Disease but cannot be used to diagnose it.

PEARLS:

• Patients may have a “Fever of Unknown Origin” type of presentation.
• ANA is negative.

COMPLICATIONS OF KAWASAKI DISEASE

Complications of Kawasaki Disease include coronary aneurysms (not during acute phase), coronary arteritis, myocardial infarction, sterile pyuria, and liver dysfunction. The cardiac disease causes the greatest morbidity, so get an echocardiogram NOW, and then repeat at 2 weeks and 6 weeks. A cardiologist should follow these patients.

TREATMENT OF KAWASAKI DISEASE

Treatment of Kawasaki Disease includes HIGH DOSE ASPIRIN (80 mg/kg) + IVIG. Cut the ASA dose once the patient is afebrile for at least 48 hours. IVIG is given as a one-time dose but may be repeated x 1. Continue ASA for a total of 6 weeks.

ENDOCARDITIS

ENDOCARDITIS DEFINITION

Endocarditis is defined as inflammation of the endocardium or heart valves. This is usually caused by an infection (infective endocarditis), but can occur with other conditions in which there is no active infection. Examples of noninfective endocarditis include Libman–Sacks endocarditis due to systemic lupus erythematosus and endocarditis due to rheumatic fever. In general, STREP VIRIDANS is the most common etiology of infectious endocarditis in children, followed by Staph aureus and then Staph epidermidis (especially if the valve is prosthetic). Findings may include fever (possibly up to 2 weeks), new murmurs (especially mitral or aortic regurgitation), petechiae, splenomegaly (from CHF), tender nodules on fingers/toes (Osler’s nodes), and nontender macules or nodules on the palms/soles (Janeway Lesions).

PEARLS: The greatest number of cases are due to Strep viridans, which typically causes a SUBACUTE infection. The most common cause of an ACUTE endocarditis is Staph aureus. Along with the acuity of the infection, also consider the entire history. If it’s post-surgical, associated with a central line or related to IV drug use, choose Staph aureus.