Supplemental lab criteria:
Process consistent with KD?
Obtain CRP and ESR
CRP >/= 30 mg/L (3.0mg/dL) or ESR >/= 40 mm/hr?
Risk of coronary aneurysm increases with:
Treatment:
Exudative conjunctivitis, exudative pharyngitis, discrete intraoral lesions, bullous or vesciular rash, generalized adenopathy all suggest alternative diagnosis.
Treatment of refractory KD:
Consider anxiolysis or sedation for echocardiogram for optimal study.
ECHO positive if 1 of these criteria met:
Consider diagnosis of Incomplete/Atypical KD
Differential diagnosis also includes: viruses (EBV, measles, adenovirus), group A strep (scarlet fever, toxic shock syndrome), systemic-onset JIA, etc
References:
1) Brian W. McCrindle, Anne H. Rowley, Jane W. Newburger, Jane C. Burns, Anne F. Bolger, Michael Gewitz, Annette L. Baker, Mary Anne Jackson, Masato Takahashi, Pinak B. Shah, Tohru Kobayashi, Mei-Hwan Wu, Tsutomu T. Saji, Elfriede Pahl and On behalf of the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Council on Epidemiology and Prevention. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. Circulation. 2017;CIR.0000000000000484, originally published March 29, 2017
2) Newburger JN, Takahashi M, Gerber MA, et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics 114(6), Dec 2004.
3) Sundel, R. Kawasaki Disease: Clinical Features and Diagnosis. UpToDate, online article accessed 12/12/16.
4) Sundel, R. Kawasaki Disease: Initial Treatment and Diagnosis. UpToDate, online article accessed 12/12/16.
5) Sundel, R. Incomplete (atypical) Kawasaki Disease. UpToDate, online article accessed 12/12/16.