WBR0011
Author | PageAuthor::Anonymous (edited by Ayokunle Olubaniyi) |
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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. The physical exam is notable for a diffuse morbilliform rash over his trunk and extremities, which also becomes confluent in the groin. Both scleras are infected and his tongue is red and bumpy on appearance. Notable lymphadenopathy is present in the anterior and posterior cervical chains.
What is the commonest and the most life-threatening complication of the disease 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 the most life-threatening complication of Kawasaki syndrome is aneurysms which is 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:: |