Kawasaki Disease and Its Most Serious Complication – A High-Yield UKMLA/PLAB Exam Scenario 👶🔥

Essential Insights for Medical Licensing Exams: Kawasaki Disease in Children

This article breaks down a high-yield paediatric scenario from the February 2025 PLAB 1 exam, focusing on Kawasaki Disease (KD) — a commonly tested topic in UKMLA, PLAB, and international medical licensing exams. Understanding its presentation, diagnosis, and complications is crucial for exam success.

📚 PLAB 1 Exam Case Scenario

A 4-year-old boy is brought to the Emergency Department with a persistent fever lasting six days. His parents report red eyes, a rash, cracked lips, and irritability with reluctance to walk. Examination reveals:

• Bilateral non-purulent conjunctivitis

• Strawberry tongue

• Erythematous palms and soles with periungual desquamation

Blood test results:

• White cell count: 18 × 10⁹/L (4-11 × 10⁹/L)

• CRP: 70 mg/L (<10 mg/L)

• ESR: 50 mm/hr (0-20 mm/hr)

• Platelets: 600 × 10⁹/L (150-450 × 10⁹/L)

• ALT: 35 U/L (5-40 U/L)

What is the most serious long-term complication associated with this condition?

A) Rheumatic heart disease
B) Pulmonary embolism
C) Coronary artery aneurysm
D) Pericarditis
E) Aortic dissection

Answer with an explanation is provided below.

Our content is updated to align with the MLA content map

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Our content is updated to align with the MLA content map 〰️

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✅ Correct Answer: C) Coronary Artery Aneurysm 🫀

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Clinical Reasoning and Explanation

🩺 Key Diagnosis – Kawasaki Disease (KD)

This child’s presentation fits classic Kawasaki Disease, a medium-vessel vasculitis predominantly affecting children under 5 years old. The diagnosis is based on:

• Fever lasting ≥5 days plus

• 4 out of 5 CRASH criteria:

  • Conjunctivitis (bilateral, non-purulent)

  • Rash (polymorphous, non-vesicular)

  • Adenopathy (cervical lymph node ≥1.5 cm, often unilateral)

  • Strawberry tongue, cracked lips, mucositis

  • Hands & feet changes (erythema, swelling, periungual peeling)

🔴 Why Coronary Artery Aneurysm is the Most Serious Complication

Kawasaki Disease can lead to immune-mediated inflammation of the coronary arteries, resulting in:

• Coronary artery dilation and

• Aneurysm formation, seen in up to 25% of untreated cases.

These aneurysms can trigger:

• Myocardial infarction (MI) 😱

• Thrombosis

• Sudden cardiac death

💉 Preventing Coronary Complications

Early treatment with IV immunoglobulin (IVIG) and aspirin within the first 10 days significantly reduces the risk of coronary aneurysm development.

❌ Why the Other Options Are Incorrect

A) Rheumatic heart disease

Rheumatic heart disease results from untreated Group A Streptococcal infection, leading to valvular heart disease. KD does not cause rheumatic heart disease.

B) Pulmonary embolism

KD does not predispose to venous thromboembolism, though it can cause platelet abnormalities. PE is not a primary concern.

D) Pericarditis

KD can cause pericarditis, but it is not the most serious complication. Coronary artery aneurysms pose a greater risk.

E) Aortic dissection

Aortic dissection is seen in connective tissue disorders (Marfan syndrome, Ehlers-Danlos syndrome) and hypertension-related aortic disease, but it is not associated with Kawasaki disease.

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Key Learning Points for PLAB 1 / UKMLA:

1. Diagnosis of Kawasaki Disease (Fever + "CRASH" criteria):

• Conjunctivitis (bilateral, non-purulent)

• Rash (polymorphous, non-vesicular)

• Adenopathy (cervical lymphadenopathy >1.5 cm, unilateral)

• Strawberry tongue, cracked lips, oral mucositis

• Hands & feet (erythema, desquamation)

2. Serious complications → Coronary artery aneurysms (risk of MI, thrombosis, sudden death).

3. Management:

• IV Immunoglobulin (IVIG) + Aspirin within 10 days of symptom onset to reduce CAA risk.

• Echocardiogram to assess coronary involvement.

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