A 3-year-old presents with 5 days of fever, a strawberry tongue, diffuse erythematous rash with sandpaper texture sparing the perioral area, and tender anterior cervical lymphadenopathy (2.5 cm). Rapid strep antigen test is positive. Treatment is commenced. At day 14, the child develops bilateral non-purulent conjunctival injection, lip erythema, and swollen red palms and soles. Which diagnosis should now be considered?
- A Incomplete Kawasaki disease triggered by the preceding streptococcal infection ✓
- B Scarlet fever desquamation phase — a normal expected finding
- C Toxic shock syndrome from streptococcal exotoxin
- D Drug hypersensitivity to amoxicillin used for treatment
Correct answer: A. Incomplete Kawasaki disease triggered by the preceding streptococcal infection
Explanation
Kawasaki disease (KD) can be triggered by preceding infections including GAS. The appearance of bilateral non-purulent conjunctivitis, lip changes, and extremity changes at day 14 after the scarlet fever rash represents classical Kawasaki features emerging after strep infection. When only 3–4 criteria are present (incomplete KD), echocardiography for coronary artery aneurysm risk is mandatory. Normal scarlet fever desquamation is peeling starting around day 7 and does not include conjunctivitis or lip changes. TSS presents acutely with shock.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.