What are the indications for treatment of Kawasaki disease in patients with prolonged fever?

Updated: Jul 29, 2018
  • Author: Tina K Sosa, MD; Chief Editor: Russell W Steele, MD  more...
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Answer

It is critical to note that certain patient populations may present with prolonged fever but with very few to none of the principal clinical features or laboratory findings. This includes infants < 6 months old and adolescents. Unfortunately, while the diagnosis is exceedingly difficult to make in these scenarios, these patients are at high risk for cardiac complications. Therefore, the diagnosis of KD and treatment with IVIG should also be considered for patients with isolated prolonged fever of unclear etiology, or prolonged fever with any of the following clinical findings:

  • Irritability
  • Aseptic meningitis
  • Unexplained or culture-negative shock
  • Isolated cervical lymphadenitis unresponsive to antibiotics
  • Retropharyngeal/parapharyngeal phlegmon unresponsive to antibiotics

Case reports have also highlighed exceedingly rare and unusual presentations of KD. Hinze et al reported a case of KD in a 3-month-old boy manifested by typical signs and CAAs but without fever. [66]  Other unusual presentations (GI bleeding, lupus-like illness in a recurrent case, rhabdomyolysis) have been published as well. [22]


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