Discussions By Condition: I cannot get a diagnosis.

I think my daughter has kawasaki's disease

Posted In: I cannot get a diagnosis. 9 Replies
  • Posted By: AJ1010
  • November 25, 2008
  • 11:52 PM

This is going to be long, sorry.

Last tuesday she was under the weather (she's 5, will be 6 next month). Wednesday she was worse and complaining of her throat and neck hurting, so to the doctor we went. He diagnosed tonsillitis and gave her penicillin. Thursday and Friday her lymph nodes in her neck were huge. They felt like grapes on one side, smaller on the other.

The nodes were better by saturday, but on Sunday I couldn't control her fever and her eyes were terribly bloodshot plus she developed what I assumed was a scarlet fever rash. (she's had little to no appetite this entire time). I took her to the ER, they diagnosed her with scarlet fever, gave us a script for ceftin, sent us home (and told us the red eyes was from such a high fever). I got one dose of the ceftin in on Monday morning, it tasted so bad she refused it on monday night. I bribed and coaxed, got her to take it, she threw it up immediately. Rash seemed mostly gone yesterday, but she said her hands and feet were itchy. I also notice that not only are her eyes bloodshot, but she has big red blood patches that you can only see when she's looking down.

Took her to the oncall doc at our healthcare center today (because her regular doc thought it could wait and I didn't). Did a rapid strep, x-ray, and bloodwork. Rapid strep came back negative, mono negative, pneumonia negative. Gave us a med I know she will take (augmentin) said he couldn't rule out kawasaki when I asked, and told us to go to her regular doc in a few days.

I managed an appointment for tomorrow, thank goodness. But I live in a really small area and feel like he's just going to blow me off when I bring up kawasaki, which he's most likely never seen before.

She has the red eyes, had the swollen lymph nodes, red lips, sore throat, fever, and rapid strep says it's not strep. There is little else that fits like Kawasaki and at this point, I feel like the doctors in this one horse town probably couldn't find their own tush, nevermind make such a tricky diagnosis correctly.

I am usually not one of those moms that freak out, but I know how important early treatment is for this.

Thanks if you got all the way through this.

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9 Replies:

  • I'm sorry to hear your little one isn't feeling very well, What I will do, since she does fit the symptoms pretty well, is a couple searches such as Kawasaki differential, Kawasaki misdiagnosis, just to see if there are any other conditions you haven't heard of that match her symptoms. I'm glad you managed to get an appointment tomorrow, let us know how it goes, hopefully if they are concerned about Kawasaki they will refer you to somewhere outside of your town, where someone has seen Kawasaki. Good luck tomorrow, I hope she feels better soon.
    qwertyuiop123 453 Replies
    • November 26, 2008
    • 00:11 AM
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  • The following can also cause red eyes, fever and rash .. i suggest to check out the rash photo at http://kidshealth.org/parent/infections/skin/rocky.html
    taniaaust1 2267 Replies
    • November 26, 2008
    • 00:49 AM
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  • Thanks for the info. I don't think it's RMSF. This is where I'm second guessing myself, because the rash was so typical scarlet fever variety on Sunday but now (and yesterday too) it's all but gone. She was complaining of itchy hands and feet, but I see no distinct changes. The lymph node swelling is either gone or very nearly gone.I know it can be atypical KD. See, she's had all the classic KD symptoms at one time or another over the last week, just not all together. I wish I could find something that outlines how long each symptom is expected to last, roughly.
    AJ1010 2 Replies
    • November 26, 2008
    • 01:16 AM
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  • I agree the most likely alternate diagnosis would be rocky mountain spotted fever. Do you live in an area with ticks? Also do you live in North or South America?
    qwertyuiop123 453 Replies
    • November 26, 2008
    • 01:16 AM
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  • Measles is much more likely... Scarlet fever rash starts on the torso and spreads outward, barely getting the peripheral extremeties. Measles rash starts on the face and upper torso and moves down.Look in her mouth for tiny white/grey dots at the posterior top of her mouth or on the buccal membrane next to the molars. This would confirm Measles.Rubella is also a possibility, although it would be less severe. Lymph node swelling can last up to 11 days from onset of fever/rash, and virus will most likely be cleared in 15 days from rash/fever.Edit: sorry, the mouth, Koplik's, spots in mouth would be gone right before the rash in measles. I'm now leaning toward rubella, because of the residual lymphodenopathy.
    nckmorris 53 Replies
    • November 26, 2008
    • 01:41 AM
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  • I agree the most likely alternate diagnosis would be rocky mountain spotted fever. Do you live in an area with ticks? Also do you live in North or South America? We do have ticks in this area, but I'm pretty sure she wasn't bitten (can never be positive with those buggers, I know). We live in northeast PA.
    AJ1010 2 Replies
    • November 26, 2008
    • 01:48 AM
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  • How did they diagnose her with scarlet fever? Did they do a blood test or just by the symptoms? I am going to suggest that her rash/swollen lymph and other symptoms may be a direct side effect to the penecillin she was initially prescribed. Penecillin is HIGHLY allergen producing and has all the side effects that she exhibited intitially. I can't stress this enough - doctors don't look for drug side effects! They just don't take the time. I have a patient whose five year old daughter developed a seizure shortly after taking an antibiotic, and went to the ER...she asked all the right questions, like "could this be a result of her taking an antibiotic?" They said "no" and to continue taking it. They did blood work and scheduled a ct scan of her head... I went to my PDR drug guide, and the drug had seizures in BOLD as a side effect!:mad: The reason I am telling you this is antibiotics often cause side effects, and sometimes they are extreme. Augmentin is a very strong antibiotic, and she may also be having some side effects from this drug as well. Please just research her meds on www.drugs.com or www.rxlist.com. With that being said, if she continues to worsen, and starts to have the peeling skin, then Kawasaki surely needs to be ruled out... IN the meantime, please get your little one on a good quality children's chewable PROBIOTIC to help keep her intestinal flora in balance and help rebuild her ravaged immune system (due to the antibiotic use). Hope she feels better soon, Best wishesDOM
    acuann 3080 Replies
    • November 26, 2008
    • 03:11 AM
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  • The rash is a Maculopapular rash. it would not be have been confused with an allergic reaction, which would result in hives.Maculopapular rashes can be cause by Measles, Rubella, Strep Pyogenes, and Rickettsia. Measles and Rubella are not normally indicated because of the high prevalence of immunizations. however, immunizations are not 100 percent. its more like 95%. Many doctors haven't seen Measles, Mumps, or Rubella, therefor it may not come to mind during differential.http://pathmicro.med.sc.edu/mhunt/meas2.jpgMeasles: initial facial an upper thorax
    nckmorris 53 Replies
    • November 26, 2008
    • 03:40 AM
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  • Has she been in the woods recently? Do you have a dog? Someone suggested scarlet fever, she has not yet been to her doctor, she is going tomorrow morning.
    qwertyuiop123 453 Replies
    • November 26, 2008
    • 06:31 AM
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