Question 11: A 4-year-old presents with fever, rash, and red, cracked lips. Physical exam reveals cervical lymphadenopathy. Which of the following disease processes is most likely?
- A. Kawasaki disease (Correct Answer)
- B. Polyarteritis nodosa
- C. Buerger's disease
- D. Infectious vasculitis
- E. Temporal arteritis
Explanation: ***Correct Option: Kawasaki disease***
- This presentation is classic for **Kawasaki disease**, characterized by fever, rash, **red cracked lips** (**strawberry tongue**), and **cervical lymphadenopathy** in a young child.
- It is an acute systemic vasculitis affecting medium-sized arteries, and the primary concern is the potential for **coronary artery aneurysms**.
*Incorrect Option: Polyarteritis nodosa*
- This is a systemic necrotizing vasculitis that typically affects **adults**, with rare incidence in childhood.
- While it can present with fever and rash, the specific mucocutaneous and lymph node findings seen here are not typical for polyarteritis nodosa.
*Incorrect Option: Buerger's disease*
- This is a segmental, inflammatory, thrombosing vasculitis that primarily affects **small and medium-sized arteries and veins** in the limbs.
- It is strongly associated with **tobacco use** and causes symptoms like intermittent claudication, Raynaud's phenomenon, and digital ischemia, which are not present in this child.
*Incorrect Option: Infectious vasculitis*
- While infections can cause vasculitis, the specific constellation of symptoms (**red cracked lips**, **strawberry tongue**, **cervical lymphadenopathy**, and rash) points more specifically to Kawasaki disease than a general infectious vasculitis.
- This is a broad category, and Kawasaki disease is a more specific and likely diagnosis given the findings in a child.
*Incorrect Option: Temporal arteritis*
- This is a vasculitis primarily affecting the **large arteries of the head and neck**, including the temporal artery.
- It almost exclusively affects **older adults** (typically over 50 years old) and presents with symptoms like headache, jaw claudication, and vision changes, which are not present in this 4-year-old.
Question 12: A 3-year-old boy is taken to the ER by his parents due to his elevated temperature. He has had a fever (>101.1 deg F) for a little over a week, and over that time, his parents noticed his eyes had gotten a little pink, and his palms and soles were red and swollen. His lips and tongue are also peeling. His parents note he has not taken any new medications, and they did not notice any runny nose, sore throat, cough, or changes in his bowel or bladder habits. In the ER, his vitals are as follows: temperature is 101.3 deg F (38.5 deg C), blood pressure is 90/60 mmHg, pulse is 125/min, and respirations are 20/min. His exam is notable for bilateral injected conjunctivae, right-sided cervical lymphadenopathy, erythematous and edematous palms and soles, and erythema multiforme-like rash over his trunk. Appropriate lab tests and imaging were performed. Which of the following is the most worrisome complication of this boy's disease process?
- A. Endocardial valve damage
- B. Toxic epidermal necrolysis
- C. Digital gangrene
- D. Coronary artery aneurysms (Correct Answer)
- E. Glomerulonephritis
Explanation: ***Coronary artery aneurysms***
- The constellation of symptoms (prolonged fever, bilateral injected conjunctivae, swollen and red palms/soles, peeling lips/tongue, cervical lymphadenopathy, rash) in a 3-year-old boy is highly suggestive of **Kawasaki disease (KD)**.
- **Coronary artery aneurysms** are the most serious and common cardiovascular complication of KD, leading to potential myocardial infarction, sudden death, or long-term cardiac issues if not properly treated.
*Endocardial valve damage*
- While KD can affect the heart, **endocardial valve damage** leading to significant valvulopathy is a less frequent and less specific complication compared to coronary artery involvement.
- Valvular issues, if present, are often transient and mild, unlike the potentially devastating and long-term consequences of coronary aneurysms.
*Toxic endodermal necrolysis*
- **Toxic epidermal necrolysis (TEN)** is a severe mucocutaneous reaction, usually triggered by medications, characterized by widespread epidermal detachment.
- The rash described in the patient (erythema multiforme-like) is distinct from the widespread blistering and skin detachment seen in TEN, and KD is not associated with TEN.
*Digital gangrene*
- While extreme peripheral ischemia can lead to **digital gangrene**, this is not a typical or common complication of Kawasaki disease.
- KD primarily affects medium-sized arteries, and although peripheral vascular changes can occur, gangrene is rare.
*Glomerulonephritis*
- **Glomerulonephritis** is an inflammatory kidney condition that involves damage to the glomeruli.
- While some renal manifestations like sterile pyuria can occur in KD, clinically significant widespread glomerulonephritis leading to renal failure is not a characteristic or major complication of Kawasaki disease.
