CWH C1359686

 Based on the handover notes for the 5-year-old boy, here’s a structured approach to the top differential diagnoses (DDx):

---

Patient Summary

• Age: 5-year-old boy

• Presentation:

  • Photophobic, miserable, cracked lips

  • Diffuse maculopapular rash and non-spiking fevers

  • Conjunctivitis, multiple small cervical lymph nodes

  • Peripheral edema, low albumin

  • Anaemia (possibly dilutional)

  • Urinary retention

• Labs/Imaging:

  • Low Na, Mg, phosphate

  • Mildly elevated inflammatory markers (CRP 119 → 67, ESR 70 → 46)

  • Imaging mostly normal except mild CXR changes and small mastoid fluid

  • Echocardiogram: mild TR

• Current Management: IV antibiotics, IVIG, aspirin, supportive care

• Working Diagnosis: Kawasaki / GAS (Group A Strep) being treated

---

Top Differential Diagnoses

1. Kawasaki Disease (KD)

   • Classic features present:

     • Fever

     • Conjunctivitis

     • Oral mucosal changes (cracked lips)

     • Rash (maculopapular)

     • Cervical lymphadenopathy

     • Peripheral edema

   • Labs: Elevated CRP/ESR, hypoalbuminemia, mild anemia, hyponatremia

   • Response to IVIG can help confirm

   • Mild TR on echo could suggest early coronary involvement

2. Systemic Infection / Sepsis (Bacterial or Viral)

   • Could present with fever, rash, malaise, conjunctivitis

   • GAS infection considered (currently on IV antibiotics)

   • Consider atypical infections: EBV, CMV, adenovirus (serology negative here)

   • Urinary retention could suggest sepsis-related autonomic involvement

3. Multisystem Inflammatory Syndrome in Children (MIS-C)

   • Post-COVID inflammatory syndrome

   • Features overlap with Kawasaki: fever, rash, conjunctivitis, edema, mucous membrane changes

   • Labs: Elevated inflammatory markers, hypoalbuminemia, sometimes cardiac involvement

   • Negative EBV/CMV helps rule out other viral triggers

---

Other Considerations

• Drug reaction / Serum sickness (less likely, no recent drug history)

• Autoimmune / Connective Tissue Disease (rare at this age, e.g., juvenile idiopathic arthritis, SLE)

• Toxic Shock Syndrome (GAS or Staphylococcal)

  • High fever, rash, hypotension, multiorgan involvement

---

Summary

Most likely: Kawasaki Disease
Close second: MIS-C (if recent COVID exposure)
Others to monitor: Severe bacterial infection (GAS sepsis/toxic shock)

---

If you want, I can make a clear table comparing Kawasaki, MIS-C, and GAS sepsis specifically for this patient’s signs, labs, and imaging, which is really useful for teaching or handover.

Do you want me to do that?