[Case study] One 3-year-old kid with persistent high fever and skin rash(Kawasaki disease)

One child, male, 3 years old, had a sudden high fever and a red rash on the chest and back. After taking the medicine for the first time, the fever subsided and the rash disappeared. After going to childcare for another day, the high fever started to persist again. Large rashes appeared on the limbs, both feet were swollen and localized pain, the outer sides of the eyes were red, the lips were bright red and dry and peeled, the lymph nodes in one side of the neck were swollen, and the tongue was bright red with dots. No sweat, no appetite, fatigue, yellow urine, no bowel movement, irritation. The right pulse is floating and fast and big, left Guan pulse is strong.

Judging from the symptoms alone, the disease meets the typical diagnostic indicators of Kawasaki disease (KD) in western medicine (mostly seen in children under 5 years old, persistent high fever, conjunctival congestion, lymphadenitis, foot swelling and pain, rash, dry strawberry tongue and lips). Kawasaki disease is a pediatric disease with certain risks. Heart problems, such as fast or irregular heartbeats, occur in about 50% of children and usually begin 1 to 4 weeks after the onset of the disease. Left untreated, half of the children with heart problems (about one in five in all) will develop the most serious heart problem, a bulge in the wall of the coronary artery (coronary aneurysm). These aneurysms can rupture or produce blood clots, which can lead to heart attacks and sudden death.

At present, there is another opinion in western medicine, that is, with the epidemic of Covid-19, the incidence of Kawasaki disease has increased significantly. It is similar to the inflammatory response in multiple organs throughout the body caused by Covid-19. Due to some differences in symptoms, it may not be classified as Kawasaki disease, but instead is called Multisystem inflammatory syndrome in children (MIS-C).

From the effect of herbal medicine with us, the rash disappeared by 80% on the second day after taking the medicine, and the high fever dropped; on the third day, the rash disappeared by more than 90%, and it was almost invisible, and turned to low-grade fever or no fever; by the fourth day the rash is almost invisible, but the redness of the lips and tongue has not completely subsided, which means that most of the heat has subsided, but it is still hidden and ready to return, and the patient still need to keep taking medicine to avoid latent heat and cause future troubles. Due to the dangerous nature of the condition, it is appropriate to wait until the internal fire is completely removed before stopping the drug. In the later period, cough symptoms appeared, which were treated according to the syndrome.

So how to understand this disease in TCM and what is the treatment principle?

For Chinese medicine, it is of little significance to distinguish the disease name and pathology of Western medicine, and it will not affect the treatment of such diseases. Traditional Chinese medicine classifies these symptoms into the category of febrile diseases(Wen Bing).