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7-year-old male with a persistent fever (>38.5C) for five days with no other symptoms. His primary care physician suspected a viral infection and prescribed acetaminophen. Eight days after his fever resolved, he developed this desquamating rash on his hands, and a strawberry tongue. We suspect Kawasaki disease. We'll do an echo tomorrow.

 

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Echo image showing a large coronary artery aneurysm (13 mm) in a 9-year-old boy with Kawasaki disease refractory to IVIG. We tried 2 doses of IVIG, pulse steroids, and infliximab. Planned to start on cyclosporine.

 

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You are called over by your neighbour who knows of your medical training. She’s distraught about her 5 year-old son’s fevers and swollen neck. Should she be worried? Her boy is still sleeping, but she relates details of the last few days. You summarize it in your mind like this...
Day 1 (starting afternoon): Intermittent mild fevers
Day 2: Mild fevers, sore throat, swollen neck (left side). Playing normally.
Day 3 (night): She checks on him at 2-3 am and he’s soaked. Fever of 102 F (38.9 C), but controlled with antipyretics. Neck is swollen on both sides, but more pronounced on the left. No pain on swallowing, no rash, no vomiting, mild diarrhea.
Day 3 1/2 (morning): He can’t turn his head. Fever. Urgent care visit. Negative for strep. Advised to continue antipyretics. No other concerns or instructions. Considered viral. 

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ABOUT FIGURE 1
LEGAL
HOW  FIGURE 1 WORKS
PRESS