There are two types of “crashes” in pediatrics:
- When a toddler crashes your blood sugar by stealing your KitKat during rounds.
- When they CRASH & BURN with a mystery fever, red eyes, strawberry tongue, and a rash that looks like it had artistic direction from Dr. Bilal Chaudhary’s 5-year-old patient’s crayon set.
That’s when you pause and think, “Could this be Kawasaki Disease?”
(And then promptly regret not reviewing the diagnostic criteria the night before.)
🧠 The Mnemonic: CRASH & BURN
The classic, time-honored way to remember the clinical criteria for Kawasaki Disease (KD) — a medium-vessel vasculitis that mainly affects children under 5.
| Mnemonic Letter | Feature | Clinical Description |
|---|---|---|
| C | Conjunctivitis | Bilateral, non-exudative, limbic-sparing 🔴 |
| R | Rash | Polymorphous (NOT vesicular), often trunk/extremities 🌸 |
| A | Adenopathy | Cervical lymph node >1.5 cm, usually unilateral 🧠 |
| S | Strawberry Tongue | Mucosal changes: fissured lips, injected pharynx, red tongue 🍓 |
| H | Hands and feet changes | Erythema, edema → later desquamation 🧤🧦 |
| & BURN | BURN = Fever | Persistent fever ≥5 days, often unresponsive to antipyretics 🌡️ |
📍 Clinical Snapshot from the Wards of Quetta
Last winter, a chubby-cheeked 4-year-old from Washuk was brought in by his mother — febrile for 6 days, irritable, lips like he just bit into 10 red chilies 🌶️, and hands puffier than post-call ankles. Dr. Bilal Chaudhary called me in during rounds and whispered, “Looks like a textbook CRASH & BURN.”
Labs showed elevated ESR, CRP, and platelets doing the Macarena. Echo? Mild coronary artery ectasia. Diagnosis: Kawasaki Disease, complete type.
We started IVIG and high-dose aspirin — by Day 3, he looked more like a boy and less like a walking rash chart.
💡 Key Clinical Pearls (Because You Will Be Asked on Rounds)
- Fever is the anchor. Without it, KD isn’t KD. Think of it as the party host.
- Coronary aneurysms are the dreaded complication — don’t delay treatment!
- Labs: Look for anemia, thrombocytosis, ↑ESR/CRP, sterile pyuria.
- Incomplete KD is common in infants <6 months — always have a low threshold for echo.
Authored by:
Dr. Aurangzaib Qambrani
📍 Sheikh Khalifa Bin Zayed Hospital, Quetta
🩺 Departments: General Medicine, Gastroenterology, Cardiac Care Unit
📚 MBBS | PLAB | MRCP (UK)
