Kawasaki disease physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]

Overview

Physical examination of patients with Kawasaki disease is usually remarkable for erythematous rash, irritability, and desquamation of skin and mucous membranes.

Physical Examination

Physical examination of patients with Kawasaki disease is usually remarkable for erythematous rash, irritability, and desquamation of skin and mucous membranes.

Appearance of the Patient

• Patients with Kawasaki usually appear lethargic.

Vital Signs

• High-grade fever

Skin

• Erythema
• Edema
• Jaundice may or may not be present
• Desquamation
  • May occur on the palms of the hand and soles of the feet, as well as perianally.
• Rash
  • Limited to groin and lower limbs
  • Pustules, macules, and pustules may be rarely seen
• Beau lines are seen as transverse grooves along finger and toe nails

HEENT

• Strawberry tongue
• Fissuring of lips
• Erythematous oropharynx without tonsillar swelling
• Conjunctival injection
• High frequency sensorineural hearing loss may or may not be present

Neck

• Cervical lymphadenopathy
  • Lymph nodes are greater than 15mm in diameter
• Neck stiffness
  • May indicate aseptic meningitis

Lung

• Pneumonitis may be present and is demonstrated by:
  • Fine crackles upon auscultation of the lung apices bilaterally
  • Rhonchi
  • Vesicular breath sounds
  • Expiratory/inspiratory wheezing

Heart

• Arrhythmia may or may not be present
• Tachycardia with regular or irregular pulse

Abdomen

• Diarrhea
• Vomiting
• Abdominal pain
• Hepatomegaly / splenomegaly / hepatosplenomegaly

Genitourinary

• Orchitis may be present

Neuromuscular

• Facial palsy may be present

Source:commons.wikimedia. org, demonstrates digital desquamation by Kawasaki_symptoms.jpg: Dong Soo Kimderivative work: Natr (talk) - Kawasaki_symptoms.jpg, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=12776192