- 1 On being a patient
- 2 Modern medicine: foundations, achievements, and limitations
- 3 Global patterns of disease and medical practice
- 4 Cell biology
- 5 Immunological mechanisms
- 6 Principles of clinical oncology
- 7 Infection
- 8 Sexually transmitted diseases and sexual health
- 9 Chemical and physical injuries and environmental factors and disease
- 10 Clinical pharmacology
- 11 Nutrition
- 12 Metabolic disorders
- 13 Endocrine disorders
- 14 Medical disorders in pregnancy
- 15 Gastroenterological disorders
- 16 Cardiovascular disorders
- 17 Critical care medicine
- 18 Respiratory disorders
- 19 Rheumatological disorders
- 19.1 Structure and function: joints and connective tissue
- 19.2 Clinical presentation and diagnosis of rheumatic disease
- 19.3 Clinical investigation
- 19.4 Back pain and regional disorders
- 19.5 Rheumatoid arthritis
- 19.6 Ankylosing spondylitis, other spondyloarthritides, and related conditions
- 19.7 Pyogenic arthritis
- 19.8 Reactive arthritis
- 19.9 Osteoarthritis
- 19.10 Crystal-related arthropathies
- 19.11 Autoimmune rheumatic disorders and vasculitides
- 19.11.1 Introduction
- 19.11.2 Systemic lupus erythematosus and related disorders
- 19.11.3 Systemic sclerosis
- 19.11.4 Polymyalgia rheumatica and temporal arteritis
- 19.11.5 Behçet’s syndrome
- 19.11.6 Sjögren’s syndrome
- 19.11.7 Polymyositis and dermatomyositis
- 19.11.8 Kawasaki’s disease
- 19.12 Miscellaneous conditions presenting to the rheumatologist
- 20 Disorders of the skeleton
- 21 Disorders of the kidney and urinary tract
- 22 Disorders of the blood
- 23 Disorders of the skin
- 24 Neurological disorders
- 25 The eye
- 26 Psychiatry and drug related problems
- 27 Forensic medicine
- 28 Sports medicine
- 29 Geratology
- 30 Pain
- 31 Palliative medicine
- 32 Biochemistry in medicine
- 33 Acute medicine
Kawasaki’s disease
- Chapter:
- Kawasaki’s disease
- Author(s):
Brian W. McCrindle
- DOI:
- 10.1093/med/9780199204854.003.191108_update_001
November 28, 2012: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.
Update:
Pathogenesis—expanded discussion to include specific evidence regarding genetic susceptibility.
Clinical features—new illustration of all of the typical physical features of the diagnostic criteria.
Risk stratification—inclusion of stress echocardiography, MR angiography, and CT angiography. Classification of coronary artery abnormalities updated to emphasize the use of z-scores and identified cutpoints.
Management—(1)General—encouragement of physical activity within the context of any restrictions. (2) Immunosuppressive—enhanced discussion of evidence regarding the role of corticosteroids, also of both risk prediction and alternative treatments for patients not responding to initial IVIG treatment. (3) Long term—discussion a role for intravascular ultrasound to characterize arterial wall structure, particularly in adults suspected of coronary artery complications related to Kawasaki’s disease.
Kawasaki’s disease is an acute, self-limited, inflammatory vasculitis of unknown aetiology, with a peak incidence under 5 years of age.
Clinical features—the diagnosis is made in the presence of persistent fever for 5 days or more and at least four of the following five clinical signs: (1) nonpurulent conjunctivitis, (2) oropharyngeal inflammation, (3) cervical lymphadenopathy, (4) polymorphous exanthem, and (5) erythema of the palms and soles with subsequent desquamation. Incomplete presentations occur in approximately 25% of patients. The primary complications are cardiac, with coronary artery dilation and aneurysms evident in approximately 15 to 25% of untreated patients....
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- 1 On being a patient
- 2 Modern medicine: foundations, achievements, and limitations
- 3 Global patterns of disease and medical practice
- 4 Cell biology
- 5 Immunological mechanisms
- 6 Principles of clinical oncology
- 7 Infection
- 8 Sexually transmitted diseases and sexual health
- 9 Chemical and physical injuries and environmental factors and disease
- 10 Clinical pharmacology
- 11 Nutrition
- 12 Metabolic disorders
- 13 Endocrine disorders
- 14 Medical disorders in pregnancy
- 15 Gastroenterological disorders
- 16 Cardiovascular disorders
- 17 Critical care medicine
- 18 Respiratory disorders
- 19 Rheumatological disorders
- 19.1 Structure and function: joints and connective tissue
- 19.2 Clinical presentation and diagnosis of rheumatic disease
- 19.3 Clinical investigation
- 19.4 Back pain and regional disorders
- 19.5 Rheumatoid arthritis
- 19.6 Ankylosing spondylitis, other spondyloarthritides, and related conditions
- 19.7 Pyogenic arthritis
- 19.8 Reactive arthritis
- 19.9 Osteoarthritis
- 19.10 Crystal-related arthropathies
- 19.11 Autoimmune rheumatic disorders and vasculitides
- 19.11.1 Introduction
- 19.11.2 Systemic lupus erythematosus and related disorders
- 19.11.3 Systemic sclerosis
- 19.11.4 Polymyalgia rheumatica and temporal arteritis
- 19.11.5 Behçet’s syndrome
- 19.11.6 Sjögren’s syndrome
- 19.11.7 Polymyositis and dermatomyositis
- 19.11.8 Kawasaki’s disease
- 19.12 Miscellaneous conditions presenting to the rheumatologist
- 20 Disorders of the skeleton
- 21 Disorders of the kidney and urinary tract
- 22 Disorders of the blood
- 23 Disorders of the skin
- 24 Neurological disorders
- 25 The eye
- 26 Psychiatry and drug related problems
- 27 Forensic medicine
- 28 Sports medicine
- 29 Geratology
- 30 Pain
- 31 Palliative medicine
- 32 Biochemistry in medicine
- 33 Acute medicine