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Abstract: This article refers to a 2-year-old child who presented with a fever that persisted for 7 days and remained high for 5 days on continuous intravenous antibiotics, with no other significant abnormal symptoms. On examination, he had conjunctival congestion in both eyes, dry and cracked mucous membranes of the mouth and lips, strawberry tongue, polymorphic rash, hard and swollen peeling of the finger ends of both hands, and enlarged lymph nodes, and the diagnosis of Kawasaki disease was considered based on clinical symptoms. The child’s symptoms gradually recovered after the administration of gammaglobulin + aspirin + vitamin C.
Basic information】Male, 2 years old
Type of disease】Kawasaki disease
Hospital】Shanghai Sixth People’s Hospital
Date of consultation】January 2022
Treatment plan】Medication (gammaglobulin + aspirin + vitamin C)
Treatment period】1 week hospitalization, followed by regular follow-up
Treatment effect] Body temperature returned to normal, conjunctiva of both eyes, throat and tongue returned to normal, torso rash subsided
I. Initial interview
The child was 2 years old and was brought to the hospital by his parents. The child had been feverish for 7 consecutive days, with a persistent high fever. A careful physical examination was done after the child’s visit, which revealed obvious conjunctival congestion in both eyes, dry lips, a prune tongue, enlarged lymph nodes palpable in the neck and axillae, a red scattered rash on the trunk and extremities, and hard swelling and a little skin flakes on the ends of the fingers of both hands. In combination with the current body temperature, Kawasaki disease was diagnosed.
II. Treatment
The child was admitted to the hospital after consultation, and the relevant tests were completed, including three major routine tests (blood, urine and stool), liver and kidney functions, electrolytes, cardiac enzyme profile, arterial blood gas, and coagulation function, etc. The diagnosis of Kawasaki disease was confirmed, with the exception of a slight increase in C-reactive protein and platelets in the routine blood tests. After treatment, the child’s body temperature gradually decreased and the physical symptoms gradually returned to normal.
III. Treatment effect
After two consecutive days of intravenous gammaglobulin infusion, the child’s body temperature gradually tended to decrease and basically returned to normal on the third day after admission, and the child’s conjunctival congestion gradually improved, the lymph nodes gradually subsided, the color of the rash on the body faded, and the hard swelling at the ends of the hands and feet slowly subsided. After the recovery of symptoms, the relevant indexes, especially the blood routine and coagulation function, were reviewed again, and there was a significant improvement compared with before admission. The child’s mental outlook has improved, his appetite has increased, and the quality of his sleep at night has improved a lot.
IV. Notes
We are glad that the child’s temperature has returned to normal after treatment and that other uncomfortable symptoms have been controlled.
1. The child needs to follow the doctor’s prescription during the treatment process, not to stop and reduce the medication at will, and to delay the inoculation of various vaccines, especially the inoculation of live toxin vaccine.
2.After the treatment, the child needs sufficient rest to avoid high activity to increase the load of heart function.
3, pay attention to the child’s oral hygiene, strengthen oral care to avoid secondary infection, lip can be coated with lip oil for care.
4. Choose soft, clean and dry clothes and bedding to avoid aggravating the rash of the affected child.
Parents should pay attention to the diet, the child needs a light diet, can eat more high-protein, high vitamin food, avoid spicy, stimulating diet.
V. Personal insight
Kawasaki disease in children is not as common as the flu. Early on, fever may be the main symptom, or even the only symptom, which is easily misdiagnosed in the early stages of the disease. However, as the disease progresses, you can often see a persistent high fever that does not subside, and active anti-infective treatment is ineffective, while a series of symptoms appear one after another on the body, such as conjunctival congestion, enlarged lymph nodes, strawberry tongue, etc. These are very valuable warning signs. In the early stage, we can first take common treatment methods, such as oral antipyretics and physical cooling above 38.5℃. After the temperature has been relieved, then carefully observe the characteristics of the child’s condition, analyze the causes of the fever, and pay close attention to whether there are any changes in the body that are characteristic of the appeal, if found, parents promptly take the child to the hospital.