 1 year old infant

 Fever of 8 days
 7 days PTC
normal CBC, UA revealed rbc of 1-3, wbc of 10-15
Consult done, given cefuroxime 30mkd no relief
 5 days PTC – maculopapular rash started
from the trunk
 1 day PTC – decrease appetite
 Consult at ER
 BP 80/60, CR 120, T 38C
 Irritable not in distress
 Macupapular rash on face, chest, extremities
 (+) cervical lymphadenopathy
 Equal chest expansion, rales bibasal, no
wheeze
 Dynamic precordium, apex at 4th LMCL
 No organomegaly
 FEPP, edematous hands and feet
DISEASE RULE IN RULE OUT
1. Kawasaki disease -Fever >5days
(impression) -Sterile pyuria
-Maculopapular rash
first appearing on
trunk then face,
extremities
-Irritable
-(+) CLAD
-Edematous hands
and feet
2. Roseola Infantum -Maculopapular rash -Fever >5days
first appearing on -Pyuria
trunk -Irritable
-(+) CLAD -Edematous hands
and feet
DISEASE RULE IN RULE OUT
3. Measles (Rubella) -Maculopapular rash -Maculopapular rash
cephalocaudal

4. German Measles - Maculopapular rash - Maculopapular rash

(rubeola) cephalocaudal
 mucocutaneous lymph node syndrome or
infantile periarteritis nodosa
 Idiopathic, self-limiting systemic vasculitis
 Usually affecting 6months – 5years
 generalized vasculitis that involves small to
medium-sized arteries
 earliest stages - of the disease, the
endothelial cells and the vascular media
become edematous, but the internal elastic
lamina remains intact
 7-9 days after fever
• an influx of neutrophils occurs, which is quickly
followed by a proliferation of CD8+ (cytotoxic)
lymphocytes and immunoglobulin A–producing
plasma cells
• inflammatory cells secrete various cytokines,
interleukins, MMPs, result in a cascade of events
that eventuates in fragmentation of the internal
elastic lamina and vascular damage
 7-9 days after fever
• media develops inflammation with necrosis of
smooth muscle cells
• internal and external elastic laminae can split,
leading to aneurysms
 few weeks to months
• active inflammatory cells are replaced by fibroblasts
and monocytes, and fibrous connective tissue
begins to form within the vessel wall
• intima proliferates and thickens
• vessel wall eventually becomes narrowed or
occluded owing to stenosis or a thrombus
 Acute stage – febrile phase
 Subacute stage
 Convalescent phase
 Irritability
 Nonexudative bilateral conjunctivitis (90%)
 Anterior uveitis (70%)
 Perianal erythema (70%)
 Erythema and edema on the hands and feet;
the latter impedes ambulation
 Strawberry tongue and lip fissures
 Hepatic, renal, and GI dysfunction
 Myocarditis and pericarditis
 Lymphadenopathy (75%)
 Afebrile and continues up to 4-6weeks
 hallmarks of this stage are desquamation of
the digits, thrombocytosis (the platelet count
may exceed 1 million/μL), and the
development of coronary aneurysms
 Risk of death is highest at this stage
 complete resolution of clinical signs of the
illness, usually within 3 months of
presentation
 No specific diagnostic test
 echocardiography
 CBC:
• Acute stage - mild-to-moderate normochromic
anemia
• Subacute stage – thrombocytosis
 chest radiograph - exclude cardiomegaly or
subclinical pneumonitis, or confirm clinical
suspicion of chronic heart failure
 Abdominal ultrasound can show evidence of
gallbladder distension.
 ECG may show a range of conduction
abnormalities due to carditis.
 fever for five or more days with at least four
of five principal clinical features: bilateral
conjunctival injection, changes in the lips and
oral cavity, cervical lymphadenopathy,
extremity changes, and polymorphous rash
 fever plus 2 or 3 of the typical features are
present for 5 days or more
 ESR is 40 mm/hr or more
 CRP is 3 mg/dL or higher
 Albumin < 3 g
 Anemia for age
 Elevated ALT level
 Platelets >450,000 (after 7 d)
 WBC count >12,000
 Presence of pyuria
 intravenous immunoglobulin (IVIG) - reduce
fever and myocardial inflammation and to
prevent or ameliorate cardiac sequelae
 Aspirin - antiplatelet and antipyretic effect
 Reevaluate all patients within 1 week of
hospital discharge
 Schedule the patient for repeat
echocardiography 21-28 days after the onset
of fever
 If baseline echocardiographic studies and
those obtained at 3-4 weeks do not show any
evidence of coronary aneurysms, further
echocardiography is usually unnecessary