(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: This is a case of a 2-year-old female child who presented 10 days ago with an unexplained high fever without coughing or vomiting, and whose parents gave ibuprofen suspension to reduce the fever symptomatically with no obvious effect. Later, a scattered red rash appeared on the chest and abdomen, which was not painful or itchy. The clinical diagnosis of Kawasaki disease was made based on the child’s medical history and signs combined with laboratory tests, and the child was given gammaglobulin, aspirin and ceftriaxone sodium medication to control her condition and her symptoms improved significantly.
Basic information】Female, more than 2 years old
Type of disease】Kawasaki disease
Hospital】Fudan University Hospital of Pediatrics
Date of consultation】March 2022
Treatment plan】Medication (high-dose gammaglobulin + aspirin + ceftriaxone sodium anti-infection)
Treatment period】10 days of hospitalization, 1 year of outpatient follow-up
Treatment effect] The disease was completely controlled and the fever and rash subsided.
I. Initial consultation
The child developed an unexplained high fever 10 days ago without coughing or vomiting, so the parents did not pay enough attention to it and only gave ibuprofen suspension to reduce the heat treatment. On the second day, the child’s fever did not subside, and a scattered red rash appeared on the chest and abdomen, which was not painful or itchy. He was examined for a temperature of 39.8°C. A scattered red rash was seen all over the body, evident in the extremities, the conjunctiva was mildly congested, evident on the left side, and mildly enlarged lymph nodes were palpable in the neck bilaterally, without pressure pain. The child was admitted to the hospital with possible Kawasaki disease.
Treatment
After admission, the child was given active anti-infection treatment, but the high fever did not subside and the body temperature always fluctuated around 39.5°C. On the second day of admission, the child’s rash increased significantly and a diffuse rash appeared all over the body, while the conjunctival congestion was more obvious and the mucous membrane of the mouth and lips was congested and chapped. The clinical diagnosis of Kawasaki disease was made based on the child’s medical history and signs combined with laboratory tests, and the child was given high-dose gammaglobulin with aspirin and anti-infective ceftriaxone sodium. On the fourth day of admission, the aspirin dose was reduced. On the tenth day of admission, the routine blood tests for leukocytes, C-reactive protein and sedimentation were normal, and the child was recommended to be discharged from the hospital and followed up regularly in the clinic for one year.
III. Treatment effect
After clinical treatment, the child’s condition improved rapidly. On the second day of treatment, the fever subsided, the rash was significantly relieved, the conjunctival congestion disappeared, the bilateral enlarged lymph nodes in the neck also disappeared, and the child’s spirit gradually improved. On the 10th day of admission, the child’s condition was stable, and the routine blood tests for leukocytes, C-reactive protein and blood sedimentation were normal.
IV. Notes
The child’s condition was completely controlled and he was successfully discharged from the hospital, so we are happy for him.
1. It is recommended that the child follow the doctor’s instructions on the correct use of medication after discharge from the hospital, forbid to stop or reduce the medication by oneself, and regular outpatient follow-up.
2, usually at home to pay attention to rest, to ensure sufficient sleep every day, can be appropriate exercise. Diet should be light, eat more high protein, high vitamin, high fiber, easy to digest food, avoid eating spicy, stimulating food. Rinse your mouth before and after eating to keep your mouth clean, and your lips can be coated with lip oil to avoid further aggravation of chapping. Choose soft, clean clothes and bedding to prevent irritation of the affected child’s skin and aggravation of the rash.
3, Kawasaki disease is an autoimmune disease, and infection is closely related, so try not to go to crowded places to avoid cross-infection.
V. Personal insight
Kawasaki disease, also known as cutaneous mucosal lymph node syndrome, is an autoimmune disease and is not uncommon in clinical practice. The clinical diagnosis of typical Kawasaki disease is not difficult, but in this case, parents are reminded that it is easy to miss the diagnosis if the child has atypical symptoms. Therefore, Kawasaki disease should be highly suspected in infants with unexplained fever, especially if the fever does not subside after aggressive anti-infective therapy, and once a clinical rash, especially conjunctival congestion, is present. Clinical tests for blood sedimentation or immunology are needed to assist in the diagnosis, and a cardiac ultrasound should be done at the first opportunity to exclude coronary artery involvement. Once the diagnosis is clear, the correct medication should be given as soon as possible, which is essential for recovery from Kawasaki disease.