Medical ConditionsCardiac & respiratory: Kawasaki disease
Medical ConditionsCardiac & respiratory: Kawasaki disease
Kawasaki disease
Also called: Mucocutaneous lymph node syndrome
Overview
Board takeaway: Defer elective care and refer suspected acute disease urgently; after recovery, review coronary status and antithrombotic therapy before surgery or anesthesia.
An acute vasculitis of young children and the leading cause of acquired heart disease in children in developed countries. Its oral signs can lead a dentist to the diagnosis, and its coronary aneurysms shape later care.
How does Kawasaki disease affect dental management?
- Acute phase: refer urgently for pediatric assessment and defer elective care.
- Do not wait: Do not wait for every classic feature or for day five when an ill child raises concern; MedlinePlus advises contacting the medical provider after four days of fever, particularly with other compatible findings.
- After recovery: consult cardiology about coronary aneurysms, ischemia, and medications
- Bleeding: Aspirin or anticoagulants increase bleeding; plan local hemostasis with cardiology and do not stop prescribed antithrombotic treatment independently
- Prophylaxis: Kawasaki disease or a coronary aneurysm alone is not an AAPD/AHA infective-endocarditis prophylaxis indication. Assess any separate qualifying cardiac condition and clarify complex anatomy with cardiology.
- Vaccination: Aspirin plus influenza or varicella raises Reye syndrome risk; children on long-term aspirin are vaccinated accordingly
Exam pearl
What is Kawasaki disease?
An acute inflammation of medium-sized blood vessels of unknown cause, mostly in children under five, that can damage the coronary arteries.
What are the main systemic features of Kawasaki disease?
- Fever: Fever lasting 5 days or more
- Eyes: Bilateral nonpurulent conjunctivitis
- Skin and extremities: Polymorphous rash; swelling and redness of hands and feet, later peeling of fingertips
- Nodes: Cervical lymphadenopathy (often one large node)
- Heart: Coronary artery aneurysms in untreated children; myocarditis
- Treatment: Treated with intravenous immunoglobulin (IVIG) and aspirin
What oral findings occur in Kawasaki disease?
- Lips: Red, dry, cracked, fissured lips
- Tongue: Strawberry tongue (prominent papillae on a red tongue)
- Mucosa: Diffuse erythema of the oral and pharyngeal mucosa
- Differential clue: No vesicles or ulcers (unlike herpetic gingivostomatitis)
A 3-year-old has fever for 6 days, red cracked lips, and a strawberry tongue. What is your next step?
- Immediate action: suspect Kawasaki disease and refer to the pediatrician or emergency department.
- Why it is urgent: early IVIG and aspirin reduce the risk of coronary aneurysms.
- Differential: scarlet fever, viral exanthems, and drug reactions.