Fever and Jaundice in a 6 year old

[DD]

Patient is a 6 year old male presenting with a 4 day history of fever, fatigue, jaundice, dark colored urine, rash and generalized weakness. He was sent in by his PCP for evaluation. The family states blood was drawn but they do not have the results of the blood work.

Exam:  AA&Ox3, mild respiratory distress, febrile at 103
ENT: Dry mucous membranes, TM's normal
Eyes: Jaundice, EOMI
Resp: Wheezes heard
Cardiac: Tachy, no murmur, gallop, friction, rub
Abd: Soft, NT, ND, normoactive BS
Skin: Generalized Jaundice, Blanchable confluent rash on the trunk and abdomen that encompasses a very large surface area particularly over the abdomen, no hand or foot involvement
Lymph: Isolated cervical lymph node

I walked out of the room without any tests and said the diagnosis to Misra. According to the discharge summary 5 days later, I was correct.

What would you do/order?

Go!

[Bjs04f]

Any pmhx, up to date on vaccines?

[Bjs04f]

recent travel or illness preceeding this

[kemple]

I would order the obv belly labs and hepatitis panel. Could be acute viral hepatitis whether that's hep b, a, or something like adeno virus idk at this point. That's my thoughts.

[Bjs04f]

Wait dan, dont order shit yet, were trying to diagnose without labs dean style

[Bjs04f]

we all agree cmp to asses liver and renal function is important, but dark urine could be bilirubin or myolobin, if bilirubin then conjugated so liver or extrahepatic blockage, lets get some more history, pmhx, meds, recent events, and go from there

[kemple]

Haha ok. Hold the orders.

[DD]

Immunizations are utd, no pmhx, no prodromal.

Kid looks sick. If you want more specifics about the physical exam I can provide them. If you want pictures I'll google similar!

[Bjs04f]

Lets see the rash. Any pharyngeal erythema or exudate, strawberry tongue, conjunctival injection or similar?

[Bjs04f]

Dustin, need more info, this case is keeping me up at night, need closure

[DD]

Sorry, been working every day.

Couldn't find a good picture of the rash but it is huge, confluent, blanching, covers most of the abdomen and torso. Typical rash you see in kiddos but bigger and more diffuse.

No conjunctival.

[kemple]

Looking like Kawasaki

[Bjs04f]

indeed it does, rash, fever, strawberry tongue, and there are reports of cholestatic jaundice in kawasaki. qucik give a ton of aspirin

[DD]

Took ya long enough!

[Bjs04f]

you didnt give us any damn info. COngrats to us dan, diagnosed without a single lab