Kawasaki disease

It's 11:17 pm. I was on call last night. We admitted a 7 month old little boy. He was really cute, but irritable. He had presented with a 12 day history of fevers, cracked lips, injected conjunctivae and a passing macular rash. He was transferred to us with suspicions that this could be Kawasaki disease.

We did indeed think this was Kawasaki. Although he did not have all the classic symptomsWe admitted him and got him started on the appropriate treatment: IVIG (Intravenous Immunoglobulin) and high dose aspirin.

Now the bad news.

We knew this could happen. We got an echocardiogram today and he has coronary artery beads that are interpreted to be signs of a coronary artery aneurysm . I am upset and depressed about this. He is 7 months old! While this is a known sequence of Kawasaki, we were hoping that we were in time with treatment.

There is something about a post-call day. You have been on for 30 hours. You are hungry, your stomach probably burns from too much coffee, eating at odd hours, disrupted sleep cycles and who knows what else. You are washed out and running on fumes. To get bad news on a day like that makes it tough.

Something hurts inside. Frustration. Couldn't, can't do anything about this bad finding. Of course, we will 'follow' and react appropriately. Possible future events include thrombosis of the coronary artery. He is 7 months old!! We will probably get a repeat echo in 6 weeks. The anuerysm could either have resolved by then or we could have a giant aneurysm. I am hoping for the best.

I think I hate Kawasaki disease. I hate that we do not know what causes it. What a tease and frustration.

This is one of those days when you wrap your coat about you and press into the cold wind to go on.

Addendum on 12/24/2006:

The follow up echo was done 6 weeks later. The arteries returned to normal. Life is sweet! Merry Christmas!