Kawasaki at the Extremes of Age: Thinking Outside the Box.

Kawasaki disease is an acute vasculitis syndrome that typically occurs in children aged 1 to 4 years. Because there is no specific diagnostic test for Kawasaki disease, the diagnosis is made clinically based on specific characteristic signs and symptoms. Cases in which patients fall outside of the typical age range are uncommon and often challenging to diagnose because they have atypical presentations. This is especially true in infants, who rarely meet all the clinical criteria required for diagnosis. Patients at the extremes of ages often have a delayed diagnosis, which can lead to worse cardiac outcomes. We describe the cases of a young infant and an older adolescent who present with Kawasaki disease. These cases illustrate the challenge of diagnosing Kawasaki disease in patients beyond the typical age range. Both patients were return visits to the emergency department after inpatient stays. When fever persists longer than 5 days, clinicians must have a high index of suspicion for Kawasaki disease in all pediatric age groups to prevent treatment delay and disease sequelae.

Acute Pediatric Liquid Nicotine Ingestions.

Electronic cigarette and vaping device use in the household represents a possible source of unintentional nicotine exposure to pediatric patients. Although most ingestions of nicotine may be mild, there is a potential for significant toxicity. Nicotine toxicity can present similarly to many other types of ingestions, which makes the history an important piece of the encounter. Treatment of nicotine toxicity is primarily supportive care directed at the presenting signs and symptoms. There is no antidotal therapy for nicotine toxicity. This review covers information that can assist clinicians who might treat a pediatric patient presenting with significant nicotine toxicity after the accidental ingestion of liquid nicotine products. [Pediatr Ann. 2023;52(5):e187-e191.].