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Kawasaki disease
Kawasaki disease is an acute vasculitis of medium-sized vessels in young children; fever for at least 5 days with mucocutaneous signs should bring it to mind, because early IVIG sharply lowers the risk of coronary artery aneurysms.
Why it matters in the exam
Kawasaki questions test three things: knowing the criteria (fever plus 4 of 5 signs), recognising incomplete Kawasaki disease in a small infant with fewer signs, and the treatment — a single dose of IVIG and aspirin. The complication on which every question rests is a coronary aneurysm, which is why the echocardiogram is the key test at diagnosis and in follow-up.
Recurring traps: peeling of the fingertips appears late (weeks 2–3) and is therefore not needed for the diagnosis; infants under 6 months often present with incomplete disease and carry the highest aneurysm risk; and live vaccines are delayed after IVIG. In recent years it is also important to separate it from MIS-C, which affects older children, with prominent abdominal symptoms and impaired cardiac function.
In the differential diagnosis, remember viral infections with a rash (adenovirus, measles), scarlet fever, drug reactions and systemic JIA. Clues that support Kawasaki disease are marked irritability, redness and induration at a BCG vaccination site in countries where it is given, and laboratory findings of a high CRP, platelets rising in the second week and a low albumin.
Key points
- Kawasaki disease: fever for at least 5 days plus 4 of 5 mucocutaneous signs.
- The main complication: coronary artery aneurysms; echo at diagnosis and in follow-up.
- Treatment: IVIG 2 g/kg as a single dose, ideally within 10 days, together with aspirin.
- Incomplete Kawasaki disease is common in infants under 6 months.
- After IVIG, live vaccines are delayed by 11 months.
Summary table
| Element | Details | Exam note |
|---|---|---|
| Fever | At least 5 days | Required for classic Kawasaki disease |
| The 5 signs | Bilateral non-exudative conjunctivitis; oral changes (strawberry tongue, cracked lips); rash; extremity changes; cervical lymphadenopathy of at least 1.5 cm | 4 of 5 are needed; the lymph node is the sign most often missing |
| Incomplete Kawasaki | Fever for at least 5 days with 2–3 signs | CRP 3.0 mg/dL or more or ESR 40 mm/h or more → supplementary tests and echo |
| Treatment | IVIG 2 g/kg given in one infusion, ideally within 10 days of fever onset; aspirin | Low-dose aspirin 3–5 mg/kg per day until a normal echo at week 6–8 |
| IVIG resistance | Fever persisting or recurring at least 36 hours after the infusion ends | A second dose of IVIG, or steroids or infliximab |
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Sources
- AHA Scientific Statement: Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease, 2017 — Diagnosis, incomplete Kawasaki disease and initial treatment
- Nelson Textbook of Pediatrics, 22nd edition (2024) — Kawasaki Disease
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.