A 6-year-old child presents with fever for 12 days, bilateral non-purulent conjunctivitis, strawberry tongue, erythema of the palms and soles, a cervical lymph node 2 cm in diameter, and a diffuse macular rash on the trunk. Echocardiography shows dilatation of the left anterior descending coronary artery. Which of the following accurately describes the vascular lesion in this condition?
- A Necrotizing granulomatous vasculitis of medium arteries
- B Fibrinoid necrosis of small vessels with antineutrophil cytoplasmic antibodies
- C Leukocytoclastic vasculitis of dermal capillaries and venules
- D Necrotizing vasculitis of medium arteries without granulomas ✓
Explanation
Kawasaki disease is a necrotizing vasculitis predominantly affecting medium-sized muscular arteries (especially coronary arteries) in young children, characterized pathologically by transmural inflammation with neutrophils, lymphocytes, and macrophages causing fibrinoid necrosis — but notably WITHOUT granuloma formation. Granulomatous medium vessel vasculitis describes polyarteritis nodosa in some contexts or Wegener granulomatosis (GPA) for small-to-medium vessels. ANCA-associated vasculitis affects small vessels; leukocytoclastic vasculitis is IgA/Henoch-Schönlein or drug-related.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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