BCG scar in Kawasaki Disease
Erythema at the site of BCG inoculation is seen in up to 50% of young infants, especially males. This phenomenon has been ascribed to cross-reactivity between mycobacterial heat shock protein (HSP) 65 and human homologue HSP 63. This can be an important clinical pointer and can aid an early diagnosis. Do look at BCG scar site when suspecting Kawasaki Disease.
It has been reported in up to 80% of children with KD and is useful in children with incomplete KD and as an adjunct investigation
Thrombocytosis & Desquamation are seen late
The subacute phase of KD occurs about 10 to 25 days after the onset of fever. This phase is often characterized by periungual desquamation of the fingers and toes. The elevation of the platelet count also usually occurs after day 10 of illness. One should not wait for these signs and delay IVIG administration as it is most effective before day 10 of illness.
ESR not good for monitoring response after IVIG administration
The ESR is a measurement of red cell aggregation. Plasma fibrinogen, total globulin, and macroglobulins all enhance red cell aggregation and sedimentation rates. Hence, once the IVIG has been given, the ESR will measure high and no longer remains a reliable indicator of inflammation. The CRP remains independent of plasma viscosity and can be followed both before and after IVIG.