A 4 year old child presents to the ER with 7 days of a measured fever, along with a progressive diffuse red maculopapular rash over the trunk and extremities. On exam, the patient has a conjunctivitis and erythematous oral mucosa. What diagnosis should be high on your differential, and why is it important to treat this condition?

Kawasaki Disease. Use the mnemonic CRASH & Burn to remember the elements of KD.

C: conjunctivitis

R: rash

A: adenopathy

S: strawberry tongue

H: hand/food involvement

Burn: fever x 5 days


Initial ED evaluation should involve laboratory studies including CRP, ESR, LFTs and UA, the latter to rule out acalculous cholecystitis and sterile pyuria, which are associated with KD. Treatment involves aspirin & IVIG, with the goal of reducing the risk of coronary artery aneurysm. The actual symptoms (above) of KD are self-limited.

thanks to Dr. Pardue for the case.