Not ‘just’ a fever….

This case is brought to you courtesy of ASK SNIFF . We are very grateful to the family of the young boy for consenting to the video being made publicly available. We hope it will be helpful for all health care professionals who deal with children.

Presenting Complaint

A 3 year old boy presents to an emergency department (ED) with a fever.

His parents describe him has having been very miserable from the start of the illness. Following a visit to his GP, he was prescribed penicillin but developed a widespread rash. He returned and an allergy was suspected. His antibiotics were switched to Clarithromycin but there was no improvement in his symptoms. 4 days into his illness he started complaining of pain in his right foot and his parents noticed he had been walking with a limp. Today they were worried he might be dehydrated as he had developed dry lips.

Initial Features

This is the child as he presents:

What additional information would you like in the history?

 

What additional clinical information would you like?

 

Diagnosis and Management

What is/are potential differential diagnoses?

 

How would you manage this child?

 

Learning

 

What are the key features?

 

Why is it a difficult diagnosis?

 

What you may not know

 

Outcome

After initial treatment our young boy started to make an improvement

Acknowledgements

A huge thanks to the family for agreeing to universal publication of this case. We are indebted to them for being able to demonstrate the key features of Kawasaki’s Disease. The video footage was obtained by Dr. Mariyum Hyrapetian who contributed to the production of this short case and we are grateful for her support as well as that of Whittington Hospital who allowed filming to take place. This video was taken as part of the ASK SNIFF research programme. ASK SNIFF (Acutely Sick Kid Safety Netting Interventions For Families) aims to to develop safety netting interventions for families to use to determine when to seek help for an acutely sick child.

ASK SNIFF 5 - Strap

References

  1. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics 2004:114:1708-33.
  2. Tsuda E, Hamaoka K, Suzuki H, Sakazaki H, Murakami Y, Nakagawa M, et al. A survey of the 3-decade outcome for patients with giant aneurysms caused by Kawasaki disease. Am Heart J 2014;167:249-58
  3. Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and longterm management of Kawasaki disease. Circulation 2004;110:2747–71
  4. Burns JC, Shike H, Gordon JB, et al. Sequelae of Kawasaki disease in adolescents and young adults. J Am Coll Cardiol 1996;2:253–7
  5. Belay ED, Maddox RA, Holman RC, et al. Kawasaki syndrome and risk factors for coronary artery abnormalities: United States, 1994–2003. Pediatr Infect Dis 2006;25:245–9
  6. Brogan PA, Bose A, Burgner D, et al. Kawasaki disease: an evidence based approach to diagnosis, treatment, and proposals for future research. Arch Dis Child 2002;86:286–90.
  7. Eleftheriou D, Levin M,Shingadia D,Tulloh R,Klein N,Brogan P Management of Kawasaki disease Arch Dis Child 2014;99:74–83 [Open Access]
  8. Harnden A, Alves B, Sheikh A. Rising incidence of Kawasaki disease in England: analysis of hospital admission data. BMJ 2002;324:1424–5.
  9. Moore A, Harnden A and Mayon-White R Recognising Kawasaki disease in UK primary care: a descriptive study using the Clinical Practice Research Datalink British Journal of General Practice 2014; 64(625) e477-e48
  10. Harnden A, Tulloh A, Burgner D. Easily Missed? Kawasaki Disease BMJ 2014;349:g533
  11. Benseler SM, McCrindle BW, Silverman ED, Tyrrell PN, Wong J, Yeung RS. Infections and Kawasaki disease: implications for coronary artery outcome. Pediatrics 2005;116:e760-6

2 thoughts on “Not ‘just’ a fever….”

  1. Excellent case and video, thank you. It might be nice to remove the title from the top of the video to preserve the mystery for the questions.

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