Paediatrics for USMLE Step 2 CK

A 5-year-old boy presents with 6 days of fever, bilateral non-exudative conjunctival injection, a strawberry tongue with cracked lips, a polymorphous truncal rash, erythema of the palms and soles, and a single 2 cm cervical lymph node. What is the most important immediate treatment?

1. Intravenous ceftriaxone for presumed bacterial infection Antibiotics do not treat a vasculitis, and the constellation here is not infectious. Delay while treating for infection is precisely how coronary aneurysms develop.
2. Supportive care and antipyretics only Wrong. Untreated Kawasaki disease carries a substantial coronary aneurysm rate. This is one of the few pediatric conditions where aspirin is used despite Reye syndrome concerns.
3. Topical treatment for the rash and ophthalmology referral for the conjunctivitis Treats individual features while missing the systemic vasculitis threatening the coronary arteries.
4. Intravenous immunoglobulin and aspirin correct Correct. This is Kawasaki disease, meeting the clinical criteria. IVIg given within 10 days of fever onset reduces the incidence of coronary artery aneurysms from around 25% to under 5%, which is the entire point of recognizing it promptly.
5. Oral corticosteroids as first-line monotherapy Steroids are used as adjunctive or rescue therapy in high-risk or IVIg-resistant disease, not as first-line monotherapy.

The point: Kawasaki: fever at least 5 days plus 4 of 5, conjunctivitis, rash, cervical adenopathy, extremity changes, mucosal changes. IVIg within 10 days plus aspirin, and an echocardiogram at diagnosis and again at follow-up.

Source: AHA scientific statement — diagnosis, treatment and long-term management of Kawasaki disease American Heart Association · tier 2, specialty society or college