Kawasaki Kenji — Kawasaki Disease: Five Days of Fever & the Coronary Threat
Five days of fever nothing touches, cracked red lips, a strawberry tongue — and arteries quietly at risk
Kenji is four. His fever has not broken in five days despite acetaminophen, his lips are cracked and bleeding, and his tongue looks like a strawberry.
Kenji has Kawasaki disease, a vasculitis of small and medium arteries in young children. The picture is five or more days of high fever unresponsive to antipyretics, bilateral nonpurulent conjunctivitis, cracked red lips and strawberry tongue, rash, swollen red hands and feet that later peel, and cervical lymphadenopathy. The danger is coronary artery aneurysm. Treatment is IV immunoglobulin plus aspirin — the rare pediatric case where aspirin is intentionally used — and live vaccines must be delayed 11 months after IVIG.
Read Kawasaki Kenji's full story →The story arc
The setup
Kenji's parents bring him in on day five of a fever that antipyretics barely touch. He is miserable and irritable.
The turn
The nurse notes red eyes without drainage, cracked red lips, a strawberry tongue, a rash and swollen red palms and soles.
The crisis
An echocardiogram is ordered because the inflammation can weaken the coronary arteries.
The save
Kenji receives IV immunoglobulin and aspirin, is monitored for heart failure during the infusion, and his parents are told to delay live vaccines for 11 months.
NCLEX study section — Kawasaki Disease: Five Days of Fever & the Coronary Threat
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Pediatrics
Take this chapter into practice questions on the same topic.