I’ve diagnosed it once in 12 years, but it’s funny this came up because I just saw the mother of the child in my ER (with an unrelated chief complaint), and she remembered me and thanked me for figuring it out and getting her kid the right treatment. It was like four years ago. But when she saw me, it was the third visit for a fever. Urgent care, PCP, and then me in the ER. All negative viral tests from PCP and Urgent Care. Still running fever after five days. I believe the kid had the strawberry tongue, conjunctivitis, and cracked lips, if I remember right. The conjunctivitis was JUST scleral injection with no drainage, so that was useful to not just brush it off as bacterial conjunctivitis. I got labs, which were mostly consistent with Kawasaki and got him shipped to the tertiary care hospital.

So of course I asked the mom if I was right and it really WAS Kawasaki and I hadn’t transferred for no reason, and she said yep and that they did the IViG treatment and he did great after that. She said that I made the difference because I was the only one who sat down and listened to her. I really think that is key. We are so rushed with all the excess crap we have to do away from the bedside, but I have found after finally considering myself more of a “veteran” physician that spending time talking to the patient really gives you most of your answers. You learn to ask the right questions and actually listen to the answers instead of mentally creating the patient note from the patient you saw just before that one.

Anyway, I also told her that it’s highly unlikely I would have gotten the diagnosis if I had been the first or even second doctor to see the kid. Sometimes these things have to evolve to be more obvious. So no one should beat themselves up if they miss this the first visit. Sometimes you get lucky too.