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Pediatrics Qbank+
Question
An 11-month-old male is seen in the emergency department due to fever, irritability over the course of 5 days, and a rash. He was seen 3 days ago in a local urgent care, where he was diagnosed with a URI and started on a course of amoxicillin. The fever did not improve, and the child developed red eyes, cracked lips, and a generalized rash over his trunk and upper extremities.
On examination, he is irritable with significant bilateral conjunctivitis. His temperature is 38.5°C (101.3°F). The lips are cracked, and the tongue is erythematous. Several cervical nodes are enlarged and tender. The tympanic membranes are within normal limits. The rash extends over the trunk and arms as noted above. Lung fields are clear and cardiac exam is unremarkable. A cardiology consult is obtained..
Which of the following is correct regarding possible coronary artery abnormalities in this child?
A. ~ 25% of untreated children will develop coronary artery aneurysms.
B. Coronary artery aneurysms typically develop within the first 5 days of fever onset.
C. Immunoglobulins must not be administered to patients with incomplete Kawasaki Disease.
D. Children < 1 year of age have a decreased risk of coronary aneurysms.
E. Aspirin therapy can be discontinued at 8 weeks for children with small coronary aneurysms.
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Answer and Explanation
Answer
A. ~ 25% of untreated children will develop coronary artery aneurysms.
Explanation
This child has clinical signs and symptoms consistent with Kawasaki disease (KD). ~ 25% of children with KD will develop coronary artery aneurysms. If KD is diagnosed promptly and treatment with intravenous immunoglobulin (IVIG) and aspirin is initiated within the first 10 days of fever onset, the risk of coronary artery aneurysms decreases to ~ 5%.
Children who meet partial criteria and are diagnosed with incomplete should be treated the same as KD.
Children at higher risk for developing coronary artery aneurysms include:
Those with late diagnosis and delayed treatment with IVIG
Boys < 1 year of age and > 9 years of age
Fever > 14 days duration and/or failure to respond to initial dose of IVIG
Abnormal lab values, including high white blood cell count, low hematocrit, low albumin, and low sodium
Aneurysms range in size and are classified from small to giant (> 8mm in diameter or a Z score ≥ 10). Small aneurysms without other complications are treated with long-term aspirin. If aneurysm regression occurs, the aspirin can be discontinued. Giant aneurysms are treated chronically with systemic anticoagulation and aspirin.
Coronary artery aneurysms are typically seen after 10 days of illness.
Board Testing Point
Recognize Kawasaki disease (KD), including the risk of coronary artery complications, and know its treatment.
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