|Author||Anonymous (Edited by Ayokunle Olubaniyi and Alison Leibowitz)|
|Exam Type||USMLE Step 2 CK|
|Prompt||A 13 year-old boy is brought to the clinic for a gradually worsening fever of 10 days duration accompanied by a diffuse rash. His mother states that the fever has been as high as 103.0°F (39.4°C) and she has kept him out of school because of this. Observed upon physical exam is a diffuse morbilliform rash over his trunk and extremities, which also becomes confluent in the groin. Both sclerae are infected and his tongue is red and bumpy on appearance. Notable lymphadenopathy is present in the anterior and posterior cervical chains.
Which of the following complications is the most common and life-threatening in this patient?
|Answer A Explanation||[[AnswerAExp::This is also a common complication of Kawasaki disease which usually responds well to intravenous immunoglobulin (IVIG) therapy. Other cardiac involvement include: cardiomyopathy and left ventricular dysfunction.]]|
|Answer B||Hearing loss|
|Answer B Explanation||Sensorineural hearing loss is a rare and transient complication. It responds promptly to intravenous immunoglobulin (IVIG) therapy.|
|Answer C||Interstitial nephritis|
|Answer C Explanation||[[AnswerCExp::Acute interstitial nephritis is a rare complication. Other urinary abnormalities associated with Kawasaki disease include: mild proteinuria, acute renal failure, hemolytic-uremic syndrome, and immune complex-mediated glomerulonephritis.]]|
|Answer D Explanation||This is rare; it responds promptly to intravenous immunoglobulin (IVIG) therapy.|
|Answer E||Coronary artery aneurysm|
|Answer E Explanation||This is the most life-threatening complication.|
|Explanation||[[Explanation::The patient in this vignette has a condition known as Kawasaki disease. Kawasaki disease is an acute febrile vasculitis affecting many systems, including the skin, nervous system, gastrointestinal tract, musculo-skeletal system, kidneys, lungs, eyes, and the hematologic system.
The most common and life-threatening complications of Kawasaki syndrome are aneurysms which are usually confined to the medium-sized vessels and classically those located in the heart. Coronary aneurysms may be small (<5 mm) or giant (>8 mm). The latter is associated with profound morbidity and mortality. High risk patients of coronary artery aneurysms include:
With identification of Kawasaki disease it is essential to schedule follow-up exams 6-8 weeks after resolution of the disease, coupled with a timely referral to a cardiologist.
|Keyword||[[WBRKeyword::Kawasaki disease]], complications of kawasaki disease|
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