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    Case Protocol Kawasaki Disease

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    Franz Salazar
    1) The patient is a 3-year old female who presented with a 9-day history of fever and was diagnosed with Kawasaki Disease. 2) On admission, she had a macular rash, conjunctival injection, cracked lips, and enlarged lymph nodes. Laboratory tests showed elevated inflammatory markers. 3) She was given IVIG and aspirin. An echocardiogram found a small pericardial effusion but was otherwise normal. She was discharged on a 3-week course of aspirin.

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    Case Protocol Kawasaki Disease

    Uploaded by

    Franz Salazar
    93 views5 pages
    1) The patient is a 3-year old female who presented with a 9-day history of fever and was diagnosed with Kawasaki Disease. 2) On admission, she had a macular rash, conjunctival injection, cracked lips, and enlarged lymph nodes. Laboratory tests showed elevated inflammatory markers. 3) She was given IVIG and aspirin. An echocardiogram found a small pericardial effusion but was otherwise normal. She was discharged on a 3-week course of aspirin.

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    Kawa sa ki

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    1) The patient is a 3-year old female who presented with a 9-day history of fever and was diagnosed with Kawasaki Disease. 2) On admission, she had a macular rash, conjunctival injection, cracked lips, and enlarged lymph nodes. Laboratory tests showed elevated inflammatory markers. 3) She was given IVIG and aspirin. An echocardiogram found a small pericardial effusion but was otherwise normal. She was discharged on a 3-week course of aspirin.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    93 views5 pages

    Case Protocol Kawasaki Disease

    Uploaded by

    Franz Salazar
    1) The patient is a 3-year old female who presented with a 9-day history of fever and was diagnosed with Kawasaki Disease. 2) On admission, she had a macular rash, conjunctival injection, cracked lips, and enlarged lymph nodes. Laboratory tests showed elevated inflammatory markers. 3) She was given IVIG and aspirin. An echocardiogram found a small pericardial effusion but was otherwise normal. She was discharged on a 3-week course of aspirin.

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    © All Rights Reserved
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    Download as docx, pdf, or txt
    of 5

    Attending Physician: Dr.

    Bernadette Balatero-Terencio Date: August 29, 2018


    Presentors: Cabili, Janina Bianca G.
    Rodriguez, Aedrian C.

    CASE PROTOCOL

    Informant: Mother
    Reliability: 85%

    IDENTIFYING DATA:
    This is a case of S.R.I., a 3-year old, female, Filipino, Seventh Day Adventist from Silang, Cavite

    CHIEF COMPLAINT: Fever

    HISTORY OF PRESENT ILLNESS:


    9 days prior to admission, patient developed high grade fever (Tmax 40.6°C) with no other
    associated signs and symptoms. Patient was given Paracetamol but was not relieved, hence was given
    Ibuprofen which afforded temporary relief. No consult done.
    8 days prior to admission, fever persisted associated with pain on the right post auricular area and
    the mother noted an enlarged lymph node measuring >1 cm, tender, well-demarcated borders. No other
    associated signs and symptoms such as cough & colds, and sore throat.
    7 days prior to admission, she was brought to a private clinic due to the persistence of symptoms
    wherein she was prescribed with Co-Amoxiclav at 33 mkday for Bacterial Lymphadenitis.
    4 days prior to admission, fever persisted now associated with 3-4 episodes of watery, brownish,
    non-bloody, and non-foul-smelling stool. They consulted to the same MD. CBC was done which revealed
    elevated WBC at 15.3 with predominance of neutrophil at 75. Antibiotic was continued.
    3 days prior to admission, she had another 2-3 episodes of watery stools and “dry lips” was noted
    by the mother. Fecalysis was done which showed: Greenish, watery, pH 7, Occult blood (+), WBC 6-10,
    RBC 1-3, E. histolytica cyst/E. dispar cysts 0-2/hpf. Patient was started with Metronidazole.
    2 days prior to admission, patient had 2 episodes of watery stool and now associated with macular
    rash on the chest and abdomen.
    1 day prior to admission, patient developed sore eyes. They contacted the same private MD, who
    suspected Kawasaki Disease, and advised admission at our institution.

    REVIEW OF SYSTEMS:
    General: (-) chills, (-) fatigability, (-) failure to thrive, (-) malaise
    Skin, Hair, and Nails: (-) itching, (-) dryness, (-) color changes, (-) peeling
    Head: (-) headache, (-) dizziness, (-) lightheadedness
    Eyes: (-) pain, (-) excessive tearing, (-) blurring of vision
    Ears: (-) hearing loss, (-) pain, (-) discharge, (-) tinnitus
    Nose: (-) discharge, (-) epistaxis
    Throat: (-) sore throat, (-) hoarseness
    Respiratory: (-) hemoptysis, (-) cough, (-) colds, (-) difficulty of breathing
    Cardiovascular: (-) chest pain, (-) palpitations, (-) orthopnea
    Gastrointestinal: (-) loss of appetite, (-) nausea, (-) constipation, (-) diarrhea, (-) abdominal pain
    Urinary: (-) dysuria, (-) polyuria, (-) oliguria
    Musculoskeletal: (-) muscle/joint pain, (-) stiffness (-) redness, (-) swelling of joints
    Neurologic: (-) fainting, (-) seizures, (-) numbness, (-) tremors
    Hematologic: (-) bleeding, (-) easy bruising
    PAST MEDICAL HISTORY:
    Patient had Hand Foot and Mouth Disease and Complex Febrile Convulsion secondary to
    Systemic Viral Illness last 2015. Patient has no known allergies to food and medications.

    FAMILY HISTORY:
    Unknown to adoptive parents

    IMMUNIZATION HISTORY:

    Vaccine Number of doses Age given


    BCG 1 at birth
    Hepatitis B 4 at birth, 6 weeks, 10 weeks, 14
    weeks
    Measles 1 9 months
    MMR 1 12 months

    BIRTH HISTORY:
    Patient was born full term to a 28-year old G4P4(4004) via Normal Spontaneous Delivery at a
    lying-in clinic. There were no fetomaternal complications. And was given to the adoptive parents the
    following day.

    NUTRITIONAL HISTORY:
    Patient was fed with expressed breast milk from birth up to 1 month then shifted to formula milk.
    She had no vitamin supplementation. Currently, she prefers vegetables, rice, and fish.

    DEVELOPMENTAL HISTORY:
    At par with age. Social smile at 2 months and can walk alone at 1 year old.

    PERSONAL AND SOCIAL HISTORY:


    The patient lives with her adoptive parents, maternal grandparents and uncle since she was 1-day
    old. Her primary caregiver was her adoptive parents. Her biological father currently works and lives at
    Quezon Province and visits her approximately 2x a month. Her drinking water comes from a potable
    water source. No smoker nor pets noted in the household.

    PHYSICAL EXAMINATION:

    General Survey: Patient was awake, weak-looking, coherent and not in cardiorespiratory distress

    Anthropometric Measurements:
    Z-score
    Weight 17.7 kg Above 0
    Height 104 cm Below +2
    BMI 16.4 Above 0
    Vital Signs:

    BP 90/60
    HR 134
    RR 32
    T 38°C

    Skin: (+) macular erythematous rash on chest, abdomen and arms, warm, good turgor and mobility

    HEENT: anicteric sclerae, (+) conjunctival injection with limbal sparing, no nasoaural discharge, no
    tonsillopharyngeal congestion, (+) dry red lips, (+) lymphadenopathy, measuring 1 x 1 cm at right
    post auricular movable, tender.

    Chest/ Lungs: Symmetrical chest expansion, clear breath sounds, no retractions

    Heart: Adynamic precordium, distinct heart sounds, no heaves nor thrusts, no palpable thrills, normal
    rate, regular rhythm, no murmur.

    Abdomen: Flabby, soft, non-tender, no lesions, no mass, no tenderness, normoactive bowel sounds.

    Genitals: Grossly female, no rashes and lesions

    Extremities: No gross deformities, no cyanosis, no edema, no tremors, full and equal pulses. Capillary
    refill time <2 seconds

    ADMITTING DIAGNOSIS: Kawasaki Disease

    COURSE IN THE WARD:


    Upon admission, patient was weak-looking, febrile at 38°C. CBC was done showing a high white
    blood cell count of 17.10, with segmenters predominance at 68% and low lymphocytes at 20. ESR was
    increased at 105 mm/hr, and CRP was positive at 130.11 mg/L. Patient put on mild hydration and was
    given Paracetamol at 10 mkdose as needed for temperature >37.8°C and Ibuprofen at 10 mkdose. IVIg
    was ordered and was referred to Pedia Cardio Service, who agreed with IVIg transfusion and was
    scheduled for 2DEcho the next day
    Upon arrival of the IVIg She was transferred to PICU for transfusion with a test dose of 8.8 cc/hr,
    17.7 cc/hr on the second hour, and 70.8 cc/hr for 10 hours and was also given Diphenhydramine 20 mg IV
    before initiating IVIg therapy.
    On the first hospital day, patient was now afebrile, with no more rashes but still with cracked red
    lips. 2D echo results was normal however small pericardial effusion was noted. Cardio service ordered for
    Aspirin to be given at 3.3 mkday once afebrile for 48 hours and once ALT, AST, and Alkaline
    Phosphatase are normal.
    On the second hospital day, Laboratory results showed normal Alkaline Phosphatase, and normal
    AST and ALT. Patient was started on Aspirin for 3 weeks.
    On the third hospital day, Aspirin was tolerated and patient may go home with home medications
    given such as Aspirin 500 mg/tab made into 60 mg/paper tab each, 1 paper tab OD for 3 weeks after
    meals.

    FINAL DIAGNOSIS: Kawasaki Disease


    LABORATORY RESULTS:

    August 4, 2018

    CBC
    RESULT REFERENCE RANGE
    RBC L 3.86 10^12/L 4.50 – 4.80 10^12/L
    Hematocrit L 0.34 L/L 0.35 – 0.41 L/L
    Hemoglobin 111 g/L 110 – 160 g/L
    WBC H 17.10 10^9/L 5.00 – 13.00 10^9/L
    Differential Count
    Lymphocyte L 20 % 28 – 49 %
    Monocyte 8% 4–9%
    Eosinophil 3% 0–3%
    Basophil 1% 1 – 3%
    Segmenters H 68 % 43 – 64 %
    Morphology
    Platelet H 515 10^9/L 150 – 450
    MCV 89.0 fL 82.0 – 91.0
    MCH 28.6 pg 27.0 – 31.0
    MCHC 32.2 g/dL 32.0 – 36.0

    RESULT REFERENCE RANGE


    ESR H 105 mm/hr 0 – 20 mm/hr

    RESULT REFERENCE RANGE


    C-Reactive Protein 130.11 mg/L (Positive) 0 – 6 mg/L

    August 5, 2018

    PEDIATRIC ECHOCARDIOGRAPHY RESULT

    Impression: Normal Intracardiac Anatomy; Normal Coronary Arteries; Small Pericardial Effusion

    FECALYSIS RESULT
    Color Brown
    Consistency Semi Formed
    Mucus +
    pH Neutral
    Occult Blood Negative
    Microscopic Exam
    Pus Cells 1 – 3/HPF
    RBC 0 – 2/HPF
    Parasite and Ova None Seen
    August 6, 2018

    RESULT REFERENCE RANGE


    Alkaline Phosphatase 163 U/L 145-420 U/L
    SGOT 31.0 U/L 20-60 U/L
    SGPT 7.0 U/L 5-45 U/L

    August 7, 2018
    STOOL CULTURE AND SENSITIVITY
    Identified Organism Klebsiella pneumoniae (HEAVY GROWTH)
    Sensitivities
    Amikacin S
    Gentamicin S
    Amoxicillin/Clavulanic Acid R
    Ceftazidime R
    Cephalothin R
    Ceftriaxone R
    Cefuroxime R
    Cefoxitin R
    Trimethoprim/Sulfamethoxazole S
    Ampicillin R
    Chloramphenicol S
    Ciprofloxacin S

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