Strawberry Kai — Kawasaki Disease
Fever ≥5 days, strawberry tongue, peeling hands — IVIG + aspirin, watch the coronaries
Kai, age 3, has had a fever over 104°F for six days that will not break with medication. His lips are cracked and red, his tongue looks like a strawberry, and his palms are peeling.
Kai has Kawasaki disease, an acute vasculitis of unknown cause that primarily strikes children under 5. High fever lasting five or more days plus conjunctivitis, cracked red lips, a strawberry tongue, a polymorphous rash, swollen extremities and cervical lymphadenopathy make up the classic picture. IVIG given within the first 10 days plus high-dose aspirin dramatically reduce the risk of coronary artery aneurysm, the disease's most feared complication.
Read Strawberry Kai's full story →The story arc
The setup
Kai's fever starts abruptly and climbs above 104°F, unresponsive to acetaminophen, while his parents assume it's just a stubborn viral illness.
The turn
By day 4 his eyes are red without discharge, his lips crack and bleed, and his tongue turns bumpy and bright red like a strawberry.
The crisis
His hands and feet become swollen and red, a rash spreads across his trunk, and a lymph node in his neck swells to over 1.5 cm — fever has now lasted 5 days.
The save
The nurse prepares for IVIG infusion and administers high-dose aspirin as ordered, monitors closely for infusion reactions, and arranges an echocardiogram to screen for coronary artery aneurysms.
NCLEX study section — Kawasaki Disease
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.