A 3-year-old boy presented with a history of fever for 7 days, redness in both eyes, maculopapular rash and swelling over hands and feet. He was diagnosed to have Kawasaki disease. Two-dimensional echocardiography was done to look for coronary artery abnormalities. Which of the following finding in two-Dimensional echocardiography suggests giant coronary artery aneurysms?
The correct answer is D) Z score >10
Kawasaki disease (KD) is a medium vessel vasculitis and coronary artery involvement is the hallmark complication in patients with KD. The American Heart Association (AHA) has recommended Z scores based on body surface area to classify coronary artery aneurysms.
Z-Score classification of coronary artery aneurysm
Reference McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, Baker AL, Jackson MA, Takahashi M, Shah PB, Kobayashi T, Wu MH, Saji TT, Pahl E; American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Council on Epidemiology and Prevention. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals from the American Heart Association. Circulation. 2017 Apr 25;135(17):e927-e999. doi: 10.1161/CIR.0000000000000484. Epub 2017 Mar 29. Erratum in: Circulation. 2019 Jul 30;140(5):e181-e184. PMID: 28356445.
By Prof Surjit Singh, Head, Department of Pediatrics and Chief, Pediatric Allergy and Immunology Unit, Advanced Pediatrics Centre, PGIMER, Chandigarh, India
Which of the following clinical manifestation is unusual for Kawasaki disease?
The correct answer is C) Vesicular rash
Dermatological manifestations are one of the hallmark clinical features of KD. A spectrum of skin manifestations may be seen in the acute phase of KD. These include macular or maculopapular erythematous skin rash, urticarial skin rash, erythema over palms and soles, edema over hands and feet and periungual peeling of the skin. However, the presence of vesicular skin rash is highly unusual in a patient with KD and should prompt the clinician to look for other possibilities.
Reference
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