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Table 1 Time line of events

From: Kawasaki disease presenting after intussusception: a case report

Date Summary from initial and follow-up visits Diagnostic testing Intervention
April 2019
Day 1
One-day history of vomiting and mucoid bloody stool. On examination, gloved finger stained with mucoid feces mixed with streaks of fresh blood. Diagnosis: possible intussusception CRP 3.05 mg/L,
WBC: 16.13 × 109/L, platelets: 466 × 109/L, Hb: 10.7 g/dL, abdominal ultrasound: target sign at right upper quadrant with peripheral vascularity
Laparotomy and manual reduction of the intussusception. Initiation of ceftriaxone and metronidazole
Day 3 Child doing well   Discharged on cefixime and metronidazole
Day 4 High-grade fevers and diarrhea. Examination: irritable, febrile, tachycardic with some dehydration, no lymphadenopathy, delayed capillary refill with peripheral cyanosis, and maculopapular rash on the back and at BCG scar site. Hyperactive bowel sounds and clean surgical wound. Diagnosis: sepsis CRP: 121 mg/L,
WBC: 16.83 × 10, platelets: 428 × 109/L, Hb: 9.1 g/dL 9/L,
stool routine, urine routine: normal
Abdominal X-ray: normal
IV amikacin + IV ceftriaxone + IV metronidazole
IV fluid bolus, then IV DNS at maintenance rate,
zinc sulfate 20 mg, ibuprofen, and paracetamol
Day 5 Persistent fever and irritability, nonpitting feet swelling, bilateral nonpurulent conjunctivitis sparing the limbus Dengue serology: negative Antibiotics continued
Day 6 Persistent fever erythematous change of the tongue, dry cracked and bleeding lips. Diagnosis: Kawasaki disease WBC: 8 × 109/L, platelets: 316 × 109/L, Hb: 8.6 g/dL
CRP: 182 mg/L
Echocardiogram: normal
IV immunoglobulin at 2 g/kg and low-dose aspirin at 3 mg/kg/day
Day 7 Fever resolved   Discharged on low-dose aspirin
May 2019 Follow-up visit: no signs and symptoms Normal echocardiogram and CRP Aspirin stopped
  1. CRP: c-reactive protein, WBC: white blood cells, Hb: hemoglobin, IV: intravenous, DNS: dextrose normal saline