A 2-year-old boy has had fever for 6 days unresponsive to paracetamol. He has bilateral non-exudative conjunctival injection, red cracked lips with a strawberry tongue, a polymorphous truncal rash, erythema and edema of both hands, and a single enlarged right cervical lymph node measuring 2 cm. What is the most appropriate initial treatment?

• A Low molecular weight heparin alone
• B Intravenous ceftriaxone for 10 days
• C Oral prednisolone taper over 4 weeks
• D Intravenous immunoglobulin with aspirin ✓

Explanation

The child fulfills classic Kawasaki disease criteria: fever beyond 5 days plus four principal features including unilateral cervical lymphadenopathy of at least 1.5 cm. First-line therapy is a single infusion of intravenous immunoglobulin (2 g/kg) with high dose aspirin, given within 10 days of onset to reduce coronary artery aneurysm formation. Antibiotics are useless because the illness is not bacterial, and steroids are reserved for IVIG resistant disease, not first line.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.