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Incomplete Kawasaki disease – high risk — RACP Paediatrics MCQ

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HardCardiologyIncomplete Kawasaki disease – high riskRACP Paediatrics

A 9-month-old infant presents with 5 days of fever, bilateral non-purulent conjunctivitis, and irritability. Only 2 principal features of KD are present but the echocardiogram shows coronary artery Z-score of +3.0. CRP is 85 mg/L. What is the most appropriate management?

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Correct answer: A — IVIg 2 g/kg + aspirin + IV methylprednisolone

This is incomplete KD in a high-risk infant (<12 months) with coronary artery aneurysm (Z-score ≥2.5). Per the RCH Melbourne KD CPG, high-risk patients (including those with coronary artery aneurysms and infants) should receive IVIg 2 g/kg + aspirin AND consideration of adjunctive corticosteroids to reduce the risk of coronary artery complications.

Reference: RCH Melbourne – 2024 – Kawasaki Disease CPG; AHA – 2024 – Kawasaki Disease Scientific Statement