PEDIATRICS
TREATMENT
■ Treatment is mostly supportive, and can include IVF if dehydrated.
■ Most patients diagnosed with HSP in the ED can be discharged to home
with follow-up through their PMD.
■ Patients who have severe abdominal pain or GI bleeding should be
admitted.
■ Steroids may reduce incidence of intussusception.
■ No known therapy is available to prevent renal complications.
COMPLICATIONS
■ Intussusception due to lead point caused by edema or hemorrhage into
bowel wall
■ Nephrotic syndrome with chronic renal disease
■ Uncommon complications include: Bowel perforation, pancreatitis,
hypertension.
Kawasaki Syndrome
■ Kawasaki syndrome is a self-limited, acute vasculitis that affects arterioles,
venules, and capillaries throughout the body.
■ It is the leading cause of acquired heart disease in children in the United
States.
■ Peak incidence is between the ages of 18 and 24 months, with the
majority of patinets <4 years old and boys affected more frequently
than girls.
■ Etiology is unknown, but may involve either an infectious agent or the
host immune response to infection.
SYMPTOMS/EXAM
There are three phases to Kawasaki syndrome (see Table 5.7).
DIFFERENTIAL
■ Infections (viral, bacterial, or rickettsial)
■ Toxic shock syndrome
■ Stevens Johnson syndrome
■ Rheumatologic conditions, such as JRA
DIAGNOSIS
Based on a series of criteria (see Table 5.8). Kawasaki syndrome should be
entertained, however, for children who have a prolonged, unexplained fever
that does not respond to antibiotics—not all patients who have Kawasaki syn-
drome may actually meet the diagnostic criteria.
TREATMENT
■ Hospitalize.
■ If Kawasaki syndrome is confidently diagnosed, start IVIG (intravenous
gamma globulin) and high-dose aspirin.