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|Prompt=A 13 year-old boy is brought to the clinic for a gradually worsening fever of 10 days duration accompanied by a diffuse rash. His mother states that the fever has been as high as 103.0°F (39.4°C) and she has kept him out of school because of this. Observed upon physical exam is a diffuse morbilliform rash over his trunk and extremities, which also becomes confluent in the groin. Both sclerae are infected and his tongue is red and bumpy on appearance. Notable lymphadenopathy is present in the anterior and posterior cervical chains. | |Prompt=A 13 year-old boy is brought to the clinic for a gradually worsening fever of 10 days duration accompanied by a diffuse rash. His mother states that the fever has been as high as 103.0°F (39.4°C) and she has kept him out of school because of this. Observed upon physical exam is a diffuse morbilliform rash over his trunk and extremities, which also becomes confluent in the groin. Both sclerae are infected and his tongue is red and bumpy on appearance. Notable lymphadenopathy is present in the anterior and posterior cervical chains. | ||
Which of the following complications is the most common and life-threatening in this patient? | Which of the following complications is the most common and life-threatening in this patient? | ||
|Explanation=The patient in this vignette has a condition known as [[Kawasaki disease]]. | |Explanation=The patient in this vignette has a condition known as [[Kawasaki disease]]. [[Kawasaki disease]] is an acute febrile vasculitis affecting many systems, including the skin, nervous system, gastrointestinal tract, musculo-skeletal system, kidneys, lungs, eyes, and the hematologic system. | ||
The most common and | The most common and life-threatening complications of Kawasaki syndrome are aneurysms which are usually confined to the medium-sized vessels and classically those located in the heart. Coronary aneurysms may be small (<5 mm) or giant (>8 mm). The latter is associated with profound morbidity and mortality. High risk patients of coronary artery aneurysms include: | ||
* Children without intravenous immunoglobulin (IVIG) within 10 days from the onset of fever | * Children without intravenous immunoglobulin (IVIG) within 10 days from the onset of fever | ||
| Line 30: | Line 30: | ||
* Patients with laboratory findings suggestive of persistent inflammation (increased ESR, C-reactive protein (CRP) or both); | * Patients with laboratory findings suggestive of persistent inflammation (increased ESR, C-reactive protein (CRP) or both); | ||
* Young children (<6 months old) or older children (>8 years old) | * Young children (<6 months old) or older children (>8 years old) | ||
* | * Patients of the male sex | ||
A careful diagnostic workup must be initiated upon identification of disease with follow-up exams 6-8 weeks after resolution of disease, coupled with a timely referral to a cardiologist. | A careful diagnostic workup must be initiated upon identification of disease with follow-up exams 6-8 weeks after resolution of disease, coupled with a timely referral to a cardiologist. | ||
|AnswerA=Myocarditis | |AnswerA=Myocarditis | ||
|AnswerAExp=This is also a common complication of Kawasaki disease which usually responds well to intravenous immunoglobulin (IVIG) therapy. Other cardiac involvement include: cardiomyopathy and left ventricular dysfunction. | |AnswerAExp=This is also a common complication of [[Kawasaki disease]] which usually responds well to intravenous immunoglobulin (IVIG) therapy. Other cardiac involvement include: cardiomyopathy and left ventricular dysfunction. | ||
|AnswerB=Hearing loss | |AnswerB=Hearing loss | ||
|AnswerBExp=Sensorineural hearing loss is a rare and transient complication. It responds promptly to intravenous immunoglobulin (IVIG) therapy. | |AnswerBExp=Sensorineural hearing loss is a rare and transient complication. It responds promptly to intravenous immunoglobulin (IVIG) therapy. | ||
|AnswerC=Interstitial nephritis | |AnswerC=Interstitial nephritis | ||
|AnswerCExp=Acute interstitial nephritis is a rare complication. Other urinary abnormalities associated with Kawasaki disease include: mild proteinuria, acute renal failure, hemolytic-uremic syndrome, and immune complex-mediated glomerulonephritis. | |AnswerCExp=Acute interstitial nephritis is a rare complication. Other urinary abnormalities associated with [[Kawasaki disease]] include: mild proteinuria, acute renal failure, hemolytic-uremic syndrome, and immune complex-mediated glomerulonephritis. | ||
|AnswerD=Pneumonitis | |AnswerD=Pneumonitis | ||
|AnswerDExp=This is rare; it responds promptly to intravenous immunoglobulin (IVIG) therapy. | |AnswerDExp=This is rare; it responds promptly to intravenous immunoglobulin (IVIG) therapy. | ||
|AnswerE=Involvement of the coronary artery | |AnswerE=Involvement of the coronary artery | ||
|AnswerEExp=This is the most life-threatening complication. | |AnswerEExp=This is the most life-threatening complication. | ||
|EducationalObjectives=Cardiac involvement, especially, the involvement of the coronary artery, leading to the development of [[coronary aneurysm]]s is the most feared complication of Kawasaki disease. The likelihood of this complication reduces with a prompt initiation of intravenous immunoglobulin (IVIG) therapy within the first 10 days of onset of symptoms. | |EducationalObjectives=Cardiac involvement, especially, the involvement of the coronary artery, leading to the development of [[coronary aneurysm]]s is the most feared complication of [[Kawasaki disease]]. The likelihood of this complication reduces with a prompt initiation of intravenous immunoglobulin (IVIG) therapy within the first 10 days of onset of symptoms. | ||
|References=Mori M, Imagawa T, Yasui K, et al. Predictors of coronary artery lesions after intravenous gamma-globulin treatment in Kawasaki disease. J Pediatr. 2000;137:177-180 | |References=Mori M, Imagawa T, Yasui K, et al. Predictors of coronary artery lesions after intravenous gamma-globulin treatment in [[Kawasaki disease]]. J Pediatr. 2000;137:177-180 | ||
|RightAnswer=E | |RightAnswer=E | ||
|WBRKeyword=Kawasaki disease, complications of kawasaki disease | |WBRKeyword=[[Kawasaki disease]], complications of kawasaki disease | ||
|Approved=No | |Approved=No | ||
|Answer=Encephalitis.,Acute tubular necrosis.,Interstitial nephritis.,Loss of pulmonary surfactant and subsequent pulmonary failure. | |Answer=Encephalitis.,Acute tubular necrosis.,Interstitial nephritis.,Loss of pulmonary surfactant and subsequent pulmonary failure. | ||
}} | }} | ||
Revision as of 13:49, 1 July 2014
| Author | PageAuthor::Anonymous (edited by Ayokunle Olubaniyi) |
|---|---|
| Exam Type | ExamType::USMLE Step 2 CK |
| Main Category | MainCategory::Pediatrics |
| Sub Category | SubCategory::Allergy/Immunology |
| Prompt | [[Prompt::A 13 year-old boy is brought to the clinic for a gradually worsening fever of 10 days duration accompanied by a diffuse rash. His mother states that the fever has been as high as 103.0°F (39.4°C) and she has kept him out of school because of this. Observed upon physical exam is a diffuse morbilliform rash over his trunk and extremities, which also becomes confluent in the groin. Both sclerae are infected and his tongue is red and bumpy on appearance. Notable lymphadenopathy is present in the anterior and posterior cervical chains.
Which of the following complications is the most common and life-threatening in this patient?]] |
| Answer A | AnswerA::Myocarditis |
| Answer A Explanation | [[AnswerAExp::This is also a common complication of Kawasaki disease which usually responds well to intravenous immunoglobulin (IVIG) therapy. Other cardiac involvement include: cardiomyopathy and left ventricular dysfunction.]] |
| Answer B | AnswerB::Hearing loss |
| Answer B Explanation | AnswerBExp::Sensorineural hearing loss is a rare and transient complication. It responds promptly to intravenous immunoglobulin (IVIG) therapy. |
| Answer C | AnswerC::Interstitial nephritis |
| Answer C Explanation | [[AnswerCExp::Acute interstitial nephritis is a rare complication. Other urinary abnormalities associated with Kawasaki disease include: mild proteinuria, acute renal failure, hemolytic-uremic syndrome, and immune complex-mediated glomerulonephritis.]] |
| Answer D | AnswerD::Pneumonitis |
| Answer D Explanation | AnswerDExp::This is rare; it responds promptly to intravenous immunoglobulin (IVIG) therapy. |
| Answer E | AnswerE::Involvement of the coronary artery |
| Answer E Explanation | AnswerEExp::This is the most life-threatening complication. |
| Right Answer | RightAnswer::E |
| Explanation | [[Explanation::The patient in this vignette has a condition known as Kawasaki disease. Kawasaki disease is an acute febrile vasculitis affecting many systems, including the skin, nervous system, gastrointestinal tract, musculo-skeletal system, kidneys, lungs, eyes, and the hematologic system.
The most common and life-threatening complications of Kawasaki syndrome are aneurysms which are usually confined to the medium-sized vessels and classically those located in the heart. Coronary aneurysms may be small (<5 mm) or giant (>8 mm). The latter is associated with profound morbidity and mortality. High risk patients of coronary artery aneurysms include:
A careful diagnostic workup must be initiated upon identification of disease with follow-up exams 6-8 weeks after resolution of disease, coupled with a timely referral to a cardiologist. |
| Approved | Approved::No |
| Keyword | [[WBRKeyword::Kawasaki disease]], WBRKeyword::complications of kawasaki disease |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |