Clinicopathological Conference: Multisystem Failure in a Child

Abstract

A 7-year-old Filipino-American female presented to the emergency department (ED) with a five-day history of lethargy, which began after a day of swimming. Four days prior to presentation, the patient had a fever to 102ЊF and abdominal pain. The parents noted ''big lymph nodes'' in her neck as well. Three days prior to presentation, the patient was seen in an ED and treated for presumptive pharyngitis with amoxicillin and ibuprofen; later that day, a truncal rash developed. On the day of presentation, the patient complained of continued fever, lethargy, anorexia, rash, and abdominal pain. She reported three days of emesis and watery diarrhea three times per day; she denied chest pain or cough. There was no past medical or surgical history. The family denied recent travel or history of tick bites.On examination, the patient was in moderate distress. The blood pressure was 68/26 mm Hg. The heart rate was 140 beats/min. Body temperature was 103.3ЊF. Room-air pulse oximetry was 98%. The head, eyes, ears, nose, and throat (HEENT) exam demonstrated bilateral scleral icterus and injection, a ''strawberry'' tongue, fissured lips, and very dry oral mucosa. On neck exam, there were large, symmetric, mobile, tender submandibular nodes. Heart rate was regular, with no murmurs or gallop. Lungs were clear to auscultation bilaterally. The abdomen was diffusely tender, but soft. Rectal exam was significant for guaiacpositive stool, but no frank blood. On pelvic exam, there was vaginal hyperemia without vaginal discharge. The skin exam showed a macular, ery-

Kawasaki disease shock syndrome: Unique and severe subtype of Kawasaki disease

“…Two hundred and fifty‐three articles on fatal KD, 154 on refractory KD and 254 on shock and KD were analyzed; only those studies that contained detailed case information and fulfilled the case definition of KDSS were included. A total of 91 cases from 41 studies fulfilled the criteria . A total of 103 cases of KDSS were reported in 16 different countries.…”

“…reported a case of KDSS in a patient with elevated N‐terminal brain natriuretic peptide and hydrocholecystitis . Chan and Chinnock reported a patient fulfilling criteria for both TSS and KDSS without coronary artery abnormalities but negative cultures, “gallbladder edema” and a “rash seen mainly across the area covered by the patient's underpants” …”

“…9 Chan and Chinnock reported a patient fulfilling criteria for both TSS and KDSS without coronary artery abnormalities but negative cultures, "gallbladder edema" and a "rash seen mainly across the area covered by the patient's underpants". 42 Since the description of TSS in 1978 by Todd et al several overlapping features have been noted. 53,56,66 In that study, seven pediatric patients presented with fever, conjunctival erythema, rash, subcutaneous edema, vomiting, diarrhea, hepatic and renal alterations and shock associated with toxin-producing Staphylococcus aureus.…”

The Clinicopathological Conference

“…1 This new section will feature cases that were presented at both the regional and national CPC competitions and provide the resident and faculty participants a forum to share with readers the hard work invested in preparation for these events.…”