Education And Debate

Lesson of the Week: Delayed diagnosis of Kawasaki disease presenting with massive lymphadenopathy and airway obstruction

BMJ 1996; 312 doi: (Published 08 June 1996) Cite this as: BMJ 1996;312:1471
  1. David Burgner, registrara,
  2. Marino Festa, registrarb,
  3. David Isaacs, headc
  1. a Department of Microbiology, Royal Alexandra Hospital for Children, Westmead, NSW 2145, Australia
  2. b Department of Intensive Care, Royal Alexandra Hospital for Children
  3. c Department of Immunology and Infectious Diseases, Royal Alexandra Hospital for Children
  1. Correspondence to: Dr Isaacs.
  • Accepted 18 March 1996

Kawasaki disease is an acute, self limiting febrile illness of infants and young children. In children under 5 years of age the incidence varies from about 3-6 per 100 000 in Europe1 to 90 per 100 000 in Japan.2 It causes coronary artery lesions in about 20% of untreated patients, up to 2% of whom die.3 Diagnosis is based on the presence of a prolonged fever (of more than five days duration) plus four of the following five signs: conjunctival injection, changes in the mucous membranes, changes in the peripheries (erythema of the palms and soles and swelling of the hands and feet), rash, and lymphadenopathy. The clinical features may be supplemented by non-specific laboratory investigations—for example, thrombocytosis and an increased erythrocyte sedimentation rate—but there is no specific diagnostic test. Prompt diagnosis permits early treatment with intravenous immunoglobulin, which reduces the incidence of coronary artery lesions by up to two thirds.4 5

Lymphadenopathy is …

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