Back to Basics: Kawaski Disease

Back to Basics: Kawasaki Disease

Lou Argentine MD



  • AKA “mucocutaneous lymph node syndrome”

  • No definitive cause, immune mediated disorder

  • Leading cause of acquired heart disease in children

  • Occurs in all ethnic groups, however incidence highest in East Asia and children of Asian descent

  • 80% of patients are <5 years old (peak between 18 and 24 months old)


  • No specific tests, diagnosis is based on clinical criteria

  • Clinical Criteria (Fever for 5 or more days PLUS 4 or more of following):

      • Skin rash - polymorphic, nonvesicular, commonly seen on trunk and extremities

      • Mucus membrane changes - strawberry tongue, erythematous/fissured lips, erythema of buccal mucosa/pharynx

      • Conjunctivitis - bilateral bulbar involvement, nonexudative

      • Changes in distal extremities - erythema/swelling of palms or soles, desquamation/peeling of fingers and toes

      • Cervical lymphadenopathy - usually unilateral, at least one node 1.5 cm or larger, non purulent

  • Serious complication: coronary artery aneurysm which can lead thrombosis

  • Incomplete Kawasaki Disease:  KD with incomplete clinical manifestations (lack sufficient signs to fulfill the diagnosis of KD), more common in young infants


  • Labs:

        • CBC : normal to elevated WBC count, normocytic anemia, thrombocytosis

        • ESR and CRP : elevated

        • Liver enzymes : elevated with hypoalbuminemia

        • Urinalysis : sterile pyuria and proteinuria

  • Imaging:

        • EKG : look for evidence of myocarditis/ pericarditis/ arrhythmia

        • CXR : look for cardiomegaly


  • Admit patients with clinical diagnosis of KD or incomplete KD for continuous cardiac monitoring and treatment / echocardiogram

  • Treatment: IVIG and ASA

        • Administration of IVIG in the acute phase (within 10 days of onset of fever) significantly reduces the prevalence of coronary artery dilation and aneurysms



Shah, BR, et al. Atlas of Pediatric Emergency Medicine. 2nd ed. New York: NY: McGraw-Hill Education, 2013.


Stone, CK, et al. Current Diagnosis and Treatment: Pediatric Emergency Medicine. New York: NY: McGraw-Hill Education, 2014.


Tintinalli, JE. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th ed.                     New York, NY: McGraw-Hill Education LLC, 2016.