A Case of Fever of Unknown Origin

[摘要] A 12-month-old previously healthy girl was admitted after having 8 days of intermittent fever and rash; she also developed bilateral hand swelling the day of admission. Her rash consisted of erythematous macules over her arms, torso, back, and face. She had no evidence of conjunctival injection, lymphadenopathy, or mucositis. On admission, she was febrile at 39.1°C, her white blood cell (WBC) count was 34 400/mm3, platelet count (PLT) 703 000/ mm3, and C-reactive protein (CRP) was >15 mg/dL. Her albumin was 3.1 g/dL. It was also noted that she had normocytic, normochromic anemia.### QuestionWhat is the clinical diagnosis? Does the patient have incomplete Kawasaki disease (KD)? ### DiscussionKD is a clinical diagnosis and therefore largely a diagnosis of exclusion. The classic diagnosis of KD is based on the presence of ≥5 days of fever and the presence of 4 of 5 principal features, including polymorphous exanthem, bilateral bulbar conjunctival injection without exudate, mucositis, cervical lymphadenopathy (>1.5 cm diameter), and changes in extremities. Current recommendations suggest following the algorithm set forth by the American Heart Association (AHA) when the classic pattern of KD is not present.1 Supplemental laboratory criteria include albumin ≤3 g/dL, anemia for age, elevation of alanine aminotransferase, PLT after 7 days ≥450 000/mm3, WBC count ≥15 000/mm3, and urine ≥10 WBCs per high-power field. Given our patient’s clinical presentation, she did not meet classic criteria but was consistent with incomplete KD via the algorithm given her supplemental criteria. She met criteria for anemia, WBC, and PLT counts.### Case ContinuationThe next day of our patient’s admission, we consulted with our infectious disease team. After reviewing her case and evaluating the patient, they also concurred with our presumptive diagnosis of incomplete KD. She was started on intravenous immunoglobulin (IVIG) and high-dose aspirin therapy per the recommended treatment …

[学科分类] 儿科学

[关键词] Campylobacter;proljev;dob