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Kawasaki disease rash — SCE Dermatology MCQ

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HardPaediatric and geneticsKawasaki disease rashSCE Dermatology

An 8-month-old has had fever for 5 days, irritability, cracked lips and a polymorphous rash. Conjunctival injection was documented on day 2 but has resolved. CRP is raised and urinalysis shows sterile pyuria; the platelet count is still normal. What is the safest interpretation?

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Reveal the answer and explanation

Correct answer: C — Assess urgently for incomplete Kawasaki disease, including features that may have resolved before presentation

Explanation lettering: E = shown as A · A = shown as D · D = shown as E

C is correct. NICE advises considering Kawasaki disease in every child with fever lasting 5 days or longer and asking about features that may have resolved. Infants may present with fewer classical signs yet have a higher risk of coronary abnormalities. A ignores the importance of the earlier documented conjunctivitis. B wrongly makes later thrombocytosis a day-5 prerequisite. D closes the differential despite inflammatory and mucocutaneous features. E reverses the age-related risk. The child requires prompt paediatric assessment, inflammatory evaluation and cardiac assessment according to the specialist pathway rather than diagnostic delay.

Reference: NICE NG143 fever in under-5s recommendations: https://www.nice.org.uk/guidance/ng143/chapter/recommendations