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Archive for the ‘Rheumatology’ Category

Kawasaki’s Disease for the Boards & Wards

Posted by medliorator on April 29, 2010

Pathophysiology:

  • necrotizing vasculitis of early childhood
  • possible infectious etiology (parvovirus B19)

Workup:

  • CBC –> normocytic anemia followed by thrombocytosis
  • ESR –> elevated
  • CRP –> elevated
  • LFTs –> low albumin

Diagnosis: clinical (“CRASH & Burn”)

  • 4 of 5 signs:
    • Conjunctivitis – bilateral nonsuppurative
    • Rash – primarily truncal
    • Adenopathy – cervical, at least 1.5cm
    • Strawberry Tongue – URI mucous membrane changes
    • Hands & feet – erythema, edema, desquamation
  • Fever x 5 days

Treatment:

  • High dose IVIG
  • High dose ASA
  • After discharge, low dose of ASA x 8 weeks

Differential:

  • Mercury poisoning (acrodynia)
  • Scarlet fever
  • Toxic shock syndrome
  • juvenile idiopathic arthritis

See also,

Kawasaki’s Disease [Inside Surgery]

Posted in Pediatrics, Rheumatology | Comments Off on Kawasaki’s Disease for the Boards & Wards

Rheumatology Pearls

Posted by medliorator on April 18, 2010

  • A positive ANCA is meaningless if the patient’s illness doesn’t resemble Wegener’s, MPA or RPGN.
  • Septic arthritis—11% mortality.
  • Underappreciated complications of immunosuppressive therapy:
    • Corticosteroids — infectious complications
    • Anti-TNFs & Rituximab — Heb B flare, acute liver failure.
    • Azathiaprine — hypersensitivity syndrome.

Hospital Medicine 2010 April 9 sessions—rheumatology pearls [Notes from Dr. RW]

Posted in Pharmacology, Rheumatology | Comments Off on Rheumatology Pearls