A 4-year-old child has had fever for 6 days with bilateral non-purulent conjunctivitis, cracked lips with strawberry tongue, rash, and swollen hands. Echocardiography reveals dilatation of the left anterior descending coronary artery (z-score +3.2). What is the NEXT best step?

• A Start high-dose aspirin alone and repeat echo in 2 weeks
• B Start systemic steroids and low-dose aspirin
• C Admit and observe; treat only if coronary artery aneurysm exceeds 8 mm
• D Administer IVIG 2 g/kg single infusion plus high-dose aspirin ✓

Explanation

This child meets criteria for complete Kawasaki disease. The standard treatment is a single infusion of IVIG 2 g/kg plus high-dose aspirin (80–100 mg/kg/day in 4 divided doses) in the acute phase. IVIG reduces coronary artery aneurysm risk from approximately 25% to <5% when given within the first 10 days of fever. A z-score >2.5 already represents small aneurysms, mandating prompt treatment. Steroids are reserved for IVIG-resistant cases.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.