Kawasaki disease vs HSP and rheumatic fever
How to tell Kawasaki disease and HSP and rheumatic fever apart when a board question makes them look alike.
Kawasaki is fever/mucocutaneous/coronary; HSP is IgA palpable purpura; rheumatic fever is post-strep Jones criteria.
Side by side
Kawasaki disease is fever for at least 5 days plus CRASH-and-burn findings: conjunctivitis, rash, adenopathy, strawberry tongue/oral mucositis, and hand-foot changes, with coronary aneurysm risk.
HSP/IgA vasculitis causes palpable purpura, arthralgia, abdominal pain, and IgA nephropathy; acute rheumatic fever follows strep and is organized by Jones criteria: carditis, migratory polyarthritis, chorea, erythema marginatum, and nodules.
Kawasaki disease causes prolonged fever, conjunctivitis, mucositis/strawberry tongue, rash, extremity changes, cervical lymphadenopathy, and coronary aneurysm risk.
HSP causes palpable purpura, arthralgia, abdominal pain, IgA nephropathy; rheumatic fever follows strep with migratory polyarthritis, carditis, chorea, erythema marginatum, nodules.
Kawasaki: fever >=5 days, CRASH findings, coronary aneurysm prevention with IVIG plus aspirin.
HSP: IgA small-vessel vasculitis with purpura/abdominal pain/renal disease. ARF: Jones criteria after group A strep.
The repair move
Before naming the answer, force the stem through the separator: Kawasaki is fever/mucocutaneous/coronary; HSP is IgA palpable purpura; rheumatic fever is post-strep Jones criteria.
Try a free question
CoreA 4-year-old child has had 7 days of high fever (40°C), bilateral nonexudative conjunctival injection, strawberry tongue with cracked lips, polymorphous truncal rash, erythema and edema of hands and feet (with subsequent desquamation), and unilateral cervical lymphadenopathy >1.5 cm. Echocardiography is critical to obtain. Which condition is most likely?
Show answer and explanation
Answer: A. Kawasaki disease. Kawasaki disease (mucocutaneous lymph node syndrome) is a medium-vessel vasculitis primarily in children <5 years. Diagnosis: fever >= 5 days PLUS at least 4 of CRASH features: Conjunctivitis (bilateral nonexudative), Rash (polymorphous), Adenopathy (cervical, usually unilateral >1.5cm), Strawberry tongue / oral mucositis / cracked lips, Hand-foot changes (erythema, edema, subsequent desquamation). MAJOR COMPLICATION: coronary artery aneurysms. TREAT: IVIG plus high-dose aspirin (ASPIRIN ALLOWED in KD).
Why the other choices are tempting
- B. HSP has palpable purpura on extensors, arthralgia, abdominal pain, IgA nephropathy.
- C. Acute rheumatic fever has migratory polyarthritis, carditis, chorea, erythema marginatum, subcutaneous nodules after strep infection.
- D. Scarlet fever has sandpaper rash, strep pharyngitis, strawberry tongue without other CRASH features.
- E. Staphylococcal scalded skin has positive Nikolsky sign with desquamation.
Flashcards
Tap a card to flip it.
What clue supports Kawasaki disease?
Choose Kawasaki disease when the stem gives this pattern: Kawasaki disease causes prolonged fever, conjunctivitis, mucositis/strawberry tongue, rash, extremity changes, cervical lymphadenopathy, and coronary aneurysm risk.
What clue supports HSP and rheumatic fever?
Choose HSP and rheumatic fever when the stem gives this contrasting pattern: HSP causes palpable purpura, arthralgia, abdominal pain, IgA nephropathy; rheumatic fever follows strep with migratory polyarthritis, carditis, chorea, erythema marginatum, nodules.
Quick answers
What is the fastest way to tell Kawasaki disease from HSP and rheumatic fever?
Kawasaki is fever/mucocutaneous/coronary; HSP is IgA palpable purpura; rheumatic fever is post-strep Jones criteria.
What is the key clue for Kawasaki disease?
Kawasaki disease is fever for at least 5 days plus CRASH-and-burn findings: conjunctivitis, rash, adenopathy, strawberry tongue/oral mucositis, and hand-foot changes, with coronary aneurysm risk.
What is the key clue for HSP and rheumatic fever?
HSP/IgA vasculitis causes palpable purpura, arthralgia, abdominal pain, and IgA nephropathy; acute rheumatic fever follows strep and is organized by Jones criteria: carditis, migratory polyarthritis, chorea, erythema marginatum, and nodules.