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Kawasaki Disease — UKMLA MCQ

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MediumPaediatricsKawasaki DiseaseUKMLAMRCGP AKTPARAMRCP Part 1

A 3-year-old boy presents with a 5-day history of high fever (up to 40°C), conjunctivitis (bilateral, non-purulent), red cracked lips, a 'strawberry tongue', and a diffuse maculopapular rash. On examination, he also has cervical lymphadenopathy and mild swelling/redness of his hands and feet. What is the most likely diagnosis?

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Correct answer: A — Kawasaki Disease

Kawasaki disease is an acute vasculitis of childhood, typically affecting children under 5. The diagnosis is clinical, based on fever lasting ≥5 days plus at least four of the five principal features: 1) Bilateral non-exudative conjunctivitis, 2) Oral mucosal changes (red/cracked lips, strawberry tongue), 3) Polymorphous rash, 4) Extremity changes (erythema/oedema of hands/feet, later periungual desquamation), 5) Cervical lymphadenopathy (>1.5 cm diameter, usually unilateral). This child meets the criteria. Measles involves cough, coryza, conjunctivitis initially, followed by a different rash pattern. Scarlet fever presents with fever, sore throat, strawberry tongue, and a fine 'sandpaper' rash, often with flushing and Pastia's lines, caused by Streptococcus pyogenes. SJS is a severe mucocutaneous reaction, usually drug-induced, with blistering and mucosal erosion. Infectious mononucleosis causes fever, pharyngitis, lymphadenopathy, and fatigue, sometimes with a rash (especially if given amoxicillin).

Reference: NICE CKS: Kawasaki disease