Thursday, December 23, 2010

Kid with a fever....remember Kawasaki disease!

If a kid has a fever, 99% of the time it is due to a cold/flu/infection. 90% of the time, the correct course of treatment is rest and fluids. If the infection is a particularly nasty bacterial infection, then antibiotics are in order. Honestly, antibiotics are rarely necessary and we definitely over prescribe them; however, this is not a post on the evils and consequences of over prescribing antibiotics.

This is a post about one of the multitude of causes that is responsible for the 1% of pediatric fevers that are not due to an infection. When I was doing my pediatric rotation, I saw a boy who had a fever for 7 days. His pediatrician assumed that the boy had an infection and sent him home without doing a thorough physical exam. Over 99% of the time, this would have been okay. Unfortunately, this was a rare occassion where the pediatrician really needed to perform a thorough examination on this child.

If the pediatrician had taken a more thorough look at this boy, he would have noticed a strawberry tongue, rash, swollen lymph nodes, and peeling of the skin around his hands and feet. The boy had Kawasaki disease. Kawasaki is an autoimmune vasculitis which results in the patient's immune system attacking medium sized arterial vessels. If this boy had been diagnosed when he saw his pediatrician, he would have been admitted to hospital, started on IVIG, and I would not have a story to write about. Unfortunately, he was not diagnosed until months later, when he developed a consequence of Kawasaki disease...coronary artery aneurysms. Now this boy is at increased risk of cardiac diease...as a child.

The lesson here isn't to always assume that your child has Kawasaki disease if they have a fever. The lesson is to make sure that your pediatrician, or any doctor you see for that matter, shows an effort to be thorough. If you have a doctor that is only willing to spend 2 minutes with you, it might be time to find another doctor. Now, it is unrealistic for you to assume your family doctor will spend 30 minutes with you if you have a cold...but if you really feel sick and your doctor doesn't seem to address your concerns, are you really receiving the health care that you want?

1 comment:

Anonymous said...

Duly noted. Thank you!