KAWASAKI DISEASE, DIAGNOSED BASED ON CLINICAL FINDINGS AND TREATED DESPITE LIMITED FACILITIES
PT Mead Johnson Nutrition
Background : Background: Diagnosis of incomplete Kawasaki Disease (KD) is challenging and should be made immediately to prevent delay of treatment. Objectives: To instantiate for general pediatricians in small town, that KD can be diagnosed based on clinical findings and treated with limited facilities.
Case Presentation Summary : Our patient is a 7 year-old girl who was admitted on her 5th days of illness due to fever, vomiting and diarrhea. Physical examination showed strawberry tongue, erythema of the lips and desquamation, lymphadenopathy on the right neck, painfull erythematous and edematous hands, feet, fingers, and toes. She had good nutritional status, normal stature and normal development. Strong history of allergy with recurrent urticaria. Laboratorium examination showed anemia with leukocytosis and neutrofilia, trombocytes was normal, however on 3rd hospital days (her 8th sick day) laboratorium examination showed thrombocytosis and increased of ESR and CRP hence diagnosed as Kawasaki Disease. Echocardiogram done by adult cardiologist showed normal result. Treatment with IVIg was given in pediatrics ward with strict monitoring for any signs of allergy. Patient was given high dose aspirin for 3 days and low dose aspirin for 8 weeks. Referral to pediatric cardiologist for repeat echocardiogram examination done after 3 weeks showed normal result.
Learning Points/Discussion : The challenges for the diagnosis and treatment of KD in small town were the absence of pediatric cardiologist as the expert who can perform echocardiogram, the availability of the laboratorium examinations and also the Immunoglobulin. Treatment of KD should be given immediately with IVIg after establishing the diagnosis to prevent cardiac complications. Referral to another city with better facilities and experienced clinicians, needs higher cost and more time which might delay treatment. Eventually, the capability for diagnosis and treatment of KD in small town could be the competency of general pediatrics. Referral to pediatric cardiologist should be done after.