INCOMPLETE KD PATHWAY IN YOUNG INFANT CWH

C1144779


11 WK OLD FEVER D5
COMPLETED IV CEFTRXN
D/W ID
US ABDOMEN
THEN IVIG

Supplementary Laboratory Information

• Albumin < 30g/L
• Anaemia for age
• White cell count > 15 E+9/L
• Platelets after 7 days >450 E + 9/L
• Elevated ALT
• Urine White Cells > 10 per high powered field

Positive Echocardiogram (any ONE of the following)

• Z score of RCA or LAD >2.5
• Japanese MOH criteria
• Any 3 suggestive features:
  - Perivascular brightness
  - Lack of tapering of coronary arteries
  - Z score > 2.0
  - Pericardial effusion
  - Mitral regurgitation
  - Impaired LV function

Late Manifestations

• The lips usually begin to dry, crack and fissure by day 6 of the illness
• The skin of the fingertips, palms ± soles begins to peel in weeks two and three
• Beau lines (transverse grooves in nailbeds) and temporary hair loss
• With no treatment, the average length of fever is 12 days, and when the fever resolves the child may remain irritable for a further 2 to 3 weeks.