Pediatric emergency medicine trisk 3005 3005

FIGURE 101.11 Cracked, erythematous lips and “strawberry” tongue in Kawasaki disease The remaining cardinal manifestations of KD vary considerably in frequency Up to one-half of children with KD not have cervical lymphadenopathy, especially children younger than years of age When present, lymphadenopathy tends to involve the anterior cervical nodes overlying the sternocleidomastoid muscle Diffuse lymphadenopathy, as well as other signs of reticuloendothelial involvement such as splenomegaly, should prompt a search for an alternative diagnosis Bilateral, nonexudative conjunctivitis is present in more than 90% of patients A predominantly bulbar injection typically begins within days of the onset of fever, and eyes eventually develop a brilliant erythema, which spares the limbus ( Fig 101.10 ) Children are also frequently photophobic, and five out of six patients have evidence of anterior uveitis during the first week of illness Consequently, in ambiguous cases, slitlamp examination may be helpful in confirming a diagnosis of KD Cracked, red lips and a strawberry tongue are characteristic of the mucositis typically seen during the first week of KD ( Fig 101.12 ) Discrete oral lesions, such as vesicles or ulcers, and tonsillar exudate, are suggestive of a viral or bacterial infection rather than KD The cutaneous manifestations of KD are polymorphous The rash typically begins as perineal erythema and desquamation, followed by macular, morbilliform, or