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Posted On : 23 Feb 2025

A 5-year-old girl was admitted with high-grade fever for 3-4 days. fever was not responding to antipyretics. there were no clinically significant signs and symptoms. diagnosis of enteric fever and malaria was made and she was placed on IV Ceftriaxone oflox Azithromycin inj. Artesunate CBC revealed TLC 9300 N 60 L30 PLATELETS 1.9LACS MP negative malaria antigen negative WIDAL negative Urine routine normal culture negative blood culture sent. The fever did not respond and antibiotics were upgraded to vancomycin. Repeat CBC TLC 4200 N 60 L 34 Platelets 1.5 Lacs ESR 16 RF negative CRP 12.2 (POSITIVE) - the possibility of Kawasaki disease. Was considered but there were no other clinical signs except for fever.
Lumbar puncture was also done and the cells were 2 all lymphocytes protein 12 culture sent.

Expert Answer :

Answer Discussion :

A

aminu abdul

0

Entirely agree

3 Days ago

4

44_Lawand Vikrant

1

Dengue like illness

3 Days ago

Z

zeinab yusufAbdirahmn

0

maybe it's a viral infection

5 Days ago

S

sarath kumar

1

The most likely diagnosis in this case appears to be Incomplete (Atypical) Kawasaki Disease (KD).

Reasoning:
Prolonged Fever: The child has persistent high-grade fever for more than 5 days, which is a hallmark of Kawasaki disease.
Negative Infectious Workup: The tests for malaria, enteric fever, and other bacterial infections (including blood and urine cultures) are negative.
Elevated CRP and ESR: Inflammatory markers (CRP 12.2, ESR 16) are elevated, supporting an inflammatory process.
Leukopenia & Normal Lumbar Puncture: The decrease in TLC (from 9300 to 4200) with normal CSF findings further reduces the likelihood of a bacterial or viral meningoencephalitis.
Absence of Classical KD Features: There are no overt clinical signs like conjunctivitis, oral changes, rash, or extremity swelling, but Incomplete Kawasaki Disease is well recognized, especially in younger children.
Next Steps:
Echocardiography: To evaluate for coronary artery abnormalities, which are crucial in Kawasaki Disease.
IVIG and Aspirin: If incomplete KD is suspected, IV Immunoglobulin (IVIG) and high-dose Aspirin should be started promptly to reduce the risk of coronary artery aneurysms.
Close Monitoring: Repeat inflammatory markers and clinical reassessment to confirm response to therapy.
Final Answer:
Incomplete Kawasaki Disease (Atypical KD) should be strongly suspected, and echocardiography along with IVIG therapy should be considered.

5 Days ago

R

Ranjit Singh

0

wrong management as adding multiple antibiotics all together and Widal in first week

6 Days ago

Answer 1

This child is likely to have Viral illness only. Pl do not start Antibiotics without any evidence of Bacterial infection and also never start Antimalarials in suspected uncomplicated malaria without documentation of Malaria parasite or indirect evidence in the form of a positive malaria antigen test. This child needs follow-up and Antipyretics in the form of Paracetamol 15 mg/kg/dose every 4 - 6 hours. There is a lot more overdoing in this child.

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