A 4-year-old with erythema of the hands and feet and lymphadenitis who repeatedly grabs at the shoulders and chest most likely has which diagnosis?

A 4-year-old with erythema of the hands and feet and lymphadenitis who repeatedly grabs at the shoulders and chest most likely has which diagnosis?

• A. Juvenile rheumatoid arthritis
• B. Scarlet fever
• C. Kawasaki disease
• D. Toxic shock syndrome

Answer: (C)

Kawasaki disease is a pediatric systemic vasculitis that classically presents in young children with fever plus mucocutaneous and lymph node findings. The combination of erythema of the hands and feet along with cervical lymphadenopathy fits the extremity changes and lymph node involvement seen in this condition, and irritability or discomfort may make a child repeatedly grab at the chest or shoulders. This constellation is much more characteristic of Kawasaki disease than the other options, which have different hallmark features: scarlet fever would show a sandpaper-like rash and other strep signs; toxic shock syndrome involves rapid onset fever with hypotension and multi-organ failure; juvenile rheumatoid arthritis is primarily persistent joint swelling and stiffness rather than an acute mucocutaneous syndrome with lymphadenopathy. Together, the presentation points to Kawasaki disease due to the combination of extremity erythema and cervical lymphadenopathy in a young child.

Kawasaki disease is a pediatric systemic vasculitis that classically presents in young children with fever plus mucocutaneous and lymph node findings. The combination of erythema of the hands and feet along with cervical lymphadenopathy fits the extremity changes and lymph node involvement seen in this condition, and irritability or discomfort may make a child repeatedly grab at the chest or shoulders. This constellation is much more characteristic of Kawasaki disease than the other options, which have different hallmark features: scarlet fever would show a sandpaper-like rash and other strep signs; toxic shock syndrome involves rapid onset fever with hypotension and multi-organ failure; juvenile rheumatoid arthritis is primarily persistent joint swelling and stiffness rather than an acute mucocutaneous syndrome with lymphadenopathy. Together, the presentation points to Kawasaki disease due to the combination of extremity erythema and cervical lymphadenopathy in a young child.