TAILIEUCHUNG - Ebook Atlas of pediatric emergency medicine (2/E): Part 2
Part 2 book “Atlas of pediatric emergency medicine” has contents: Rheumatology, gastrointestinal disorders, endocrinology, environmental emergencies, orthopedics, emergency ultrasound, trauma, orthopedics, and other contents. | RHEUMATOLOGY Chapter 12 RHEUMATOLOGY Binita R. Shah Raynaud phenomenon 453 KAWASAKI DISEASE Clinical Summary Kawasaki disease (KD; also known as mucocutaneous lymph node syndrome) is an immune-mediated disorder of unknown etiology that occurs in genetically predisposed children leading to endothelial cell injury and vasculitis of mainly mediumsized arteries (predilection for coronary arteries). Small arterioles, larger arteries, capillaries, and veins are affected to a lesser extent. KD occurs in all ethnic groups; however, incidence is highest in East Asia and in children of Asian descent. Clinical and epidemiologic features strongly support an infectious etiology. About 80% of patients are 5 days even in the absence of other clinical criteria. Prolonged fever may be the sole manifestation of KD in infants. 7. Leukopenia and a normal ESR in an infant or child with fever, rash, and red eyes does not suggest a laboratory profile compatible with KD (suggests a viral infection). 8. Acute adenoviral infection shares many features of KD. Purulent conjunctivitis and exudative pharyngitis suggests adenoviral infection, whereas perineal desquamation, extremity changes, and sterile pyuria suggest KD. ■ 457 FIGURE ■ Incomplete Kawasaki Disease (KD). (A, B) Desquamation of the hand and foot are shown in 2 different infants (not suspected of having KD) who remained extremely irritable and highly febrile and not responding to IV antibiotics given for a clinical diagnosis of sepsis (all cultures negative). Prolonged fever followed by peripheral desquamation is among the most common signs of incomplete KD. ECHO in both these infants showed coronary artery dilation. (Photo contributor: Binita R. Shah, MD.) 9. Exudative conjunctivitis, Koplik spots, cough, and rash starting on face behind the ears, becoming confluent, and fading with a brownish hue suggest measles. KD rash is most prominent on the trunk and extremities and fades abruptly without residua. Perineal .
đang nạp các trang xem trước
