A 2-year-old has had fever for 5 days with bilateral non-exudative conjunctival injection, dry cracked lips, strawberry tongue, and indurated edema of the hands and feet. On day 13 the fever resolves and peeling begins at the fingertips. Which investigation is mandatory at this stage?

• A Blood culture
• B Lumbar puncture
• C Serial echocardiography for coronary artery aneurysms ✓
• D Skin biopsy of the desquamating area

Explanation

The picture fulfills criteria for Kawasaki disease, where the key complication is coronary artery aneurysm developing between weeks 1 and 6. Serial echocardiography is mandatory even after defervescence, along with intravenous immunoglobulin and aspirin if not already given. Blood cultures are sterile in this immune-mediated vasculitis, lumbar puncture shows aseptic pleocytosis only if meningeal signs exist, and the desquamation itself needs no biopsy.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.