Medical Student Teaching #3
Presenting Complaint - Paediatric Fever
THIS teaching session concerns a three year old Japanese boy whom you see in A&E. His mother informs you that he has had a fever for seven days, which began soon after a ride on his father’s motorcycle. He has been crying excessively, more so over the last 48 hours. He has vomited and had an episode of diarrhoea. The toddler has been rather drowsy and occasionally makes a low-pitched humming noise and holds his hands out in front of him. His mother also reports that her son frequently places bowls on his head when he does this.
On examination the young boy is crying and has a fever of 38.9C. His heart rate is 120. You notice cracked and red lips, a blotchy rash and peeling hands. On auscultation you notice that the child is Vrrroooooom test positive. You order some investigations:
ECG – prolonged PR interval
ESR – 88mm/hr
Echo – ?Mild ectasia.
You are not entirely sure until a passing mime artist gestures that you should check the blood film, shown below.
What's the diagnosis?
That's right, it's Kawasaki’s Disease. The presence of minute Japanese motorbikes in the blood is pathognomonic for Kawasaki’s. One must remember to use the maximum possible magnification, as very small motorbikes can often be mistaken for endoplasmic reticula. One must be mindful to distinguish between the harmless Suzuki vasculitis and the rapidly fatal Yamaha fever – make a Kwik-Fit referral.
Kawasaki’s is often associated with Ruff Ryder’s Syndrome - treatment involves gradually starving the child of petrol, replacing this with diesel and playing DMX music on loop. Prescribe steroids, they never do any harm. Honestly, they're fucking awesome.
Medical Student Teaching #1
Medical Student Teaching #2
Originally published in Medical Student Newspaper.
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