Kawasaki disease

Last updated: September 16, 2023

Summarytoggle arrow icon

Kawasaki disease is an acute, necrotizing vasculitis of unknown etiology. The condition primarily affects children under the age of five and is more common among those of Asian descent. The disease is characterized by a high fever, desquamative rash, conjunctivitis, mucositis (e.g., “strawberry tongue”), cervical lymphadenopathy, as well as erythema and edema of the distal extremities. However, coronary artery aneurysms are the most concerning possible manifestation as they can lead to myocardial infarction or arrhythmias. Kawasaki disease is a clinical diagnosis, further supported by findings such as elevated ESR or evidence of cardiac involvement on echocardiography. Treatment with IV immunoglobulins and high-dose aspirin is essential and should be initiated immediately after diagnosis.

Epidemiologytoggle arrow icon

  • Sex: > (1.5:1) [1]
  • Age: : primarily children < 5 years (most common cause of acquired coronary artery disease in children) [2][3]
  • Peak incidence: occurs mostly in late winter and spring
  • Prevalence [2]
    • Approx. 20 per 100,000 children
    • Highest rate in children of Asian and Pacific-Islander descent
  • Mortality: < 0.5% [4]

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

  • The exact cause of Kawasaki disease remains uncertain.
  • However, it is associated with infectious and genetic factors (the prevalence is higher in patients of Asian descent and in siblings of affected children). [5]

Clinical featurestoggle arrow icon

  • Clinical diagnosis requires fever for at least 5 days and one of the following: [6]
    • ≥ 4 other specific symptoms
    • < 4 specific symptoms and involvement of the coronary arteries
  • Specific symptoms include:
    • Erythema and edema of hands and feet, including the palms and soles (the first week)
    • Possible desquamation of fingertips and toes after 2–3 weeks
    • Polymorphous rash, originating on the trunk
    • Painless bilateral “injected” conjunctivitis without exudate
    • Oropharyngeal mucositis
    • Cervical lymphadenopathy (mostly unilateral)
  • Nonspecific symptoms may precede the onset of Kawasaki disease (e.g., diarrhea, fatigue, abdominal pain, arthritis, hoarseness, breathing difficulties) [7]

Always consider Kawasaki disease in small children with a rash and high fever unresponsive to antibiotics.

“CRASH and BURN”: Conjunctivitis, Rash, Adenopathy, Strawberry tongue, Hands and feet, and BURN (fever ≥ 5 days) are the most common features of Kawasaki disease.

Diagnosticstoggle arrow icon

Kawasaki disease is a clinical diagnosis (see “Clinical features” above) which is supported by the following diagnostic findings:

Treatmenttoggle arrow icon

  • IV immunoglobulin (IVIG)
    • High single-dose to reduce the risk of coronary artery aneurysms
    • Most effective if given within the first 10 days following disease onset [9]
  • High-dose oral aspirin [10][11]
  • IV glucocorticoids: may be considered in addition to standard treatment, esp. in cases of treatment-refractory disease, as they lower the risk of coronary involvement

To avoid the risk of Reye syndrome, children should not be treated with aspirin, especially if a viral infection is suspected. Kawasaki disease is an exception to this rule.

Complicationstoggle arrow icon

We list the most important complications. The selection is not exhaustive.

Referencestoggle arrow icon

  1. Huang WC, Huang LM, Chang IS, Chang LY, Chiang BL, Chen PJ, Wu MH, Lue HC, Lee CY, Kawasaki Disease Research Group.. Epidemiologic features of Kawasaki disease in Taiwan, 2003-2006.. Pediatrics. 2009; 123 (3): p.e401-5.doi: 10.1542/peds.2008-2187 . | Open in Read by QxMD
  2. Holman RC, Belay ED, Christensen KY, Folkema AM, Steiner CA, Schonberger LB. Hospitalizations for Kawasaki syndrome among children in the United States, 1997-2007.. The Pediatric infectious disease journal. 2010; 29 (6): p.483-8.doi: 10.1097/INF.0b013e3181cf8705 . | Open in Read by QxMD
  3. Saguil A, Fargo M, Grogan S. Diagnosis and management of kawasaki disease.. American family physician. 2015; 91 (6): p.365-71.
  4. de La Harpe M, di Bernardo S, Hofer M, Sekarski N. Thirty Years of Kawasaki Disease: A Single-Center Study at the University Hospital of Lausanne.. Frontiers in pediatrics. 2019; 7: p.11.doi: 10.3389/fped.2019.00011 . | Open in Read by QxMD
  5. Uehara R, Yashiro M, Nakamura Y, Yanagawa H. Kawasaki disease in parents and children.. Acta paediatrica (Oslo, Norway : 1992). 2003; 92 (6): p.694-7.doi: 10.1080/08035320310002768 . | Open in Read by QxMD
  6. AHA. Diagnostic Guidelines for Kawasaki Disease. Circulation. 2001; 103 (2): p.335-336.doi: 10.1161/01.CIR.103.2.335 . | Open in Read by QxMD
  7. Leuin SC, Shanbhag S, Lago D, et al. Hoarseness as a Presenting Sign in Children With Kawasaki Disease. Pediatr Infect Dis J. 2013; 32 (12): p.1392-1394.doi: 10.1097/inf.0b013e3182a0960b . | Open in Read by QxMD
  8. Newburger JW, et al.. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association.. Circulation. 2004; 110 (17): p.2747-71.doi: 10.1161/01.CIR.0000145143.19711.78 . | Open in Read by QxMD
  9. Oates-Whitehead RM, Baumer JH, Haines L, Love S, Maconochie IK, Gupta A, Roman K, Dua JS, Flynn I. Intravenous immunoglobulin for the treatment of Kawasaki disease in children.. The Cochrane database of systematic reviews. 2003: p.CD004000.doi: 10.1002/14651858.CD004000 . | Open in Read by QxMD
  10. Newburger JW, Takahashi M, Beiser AS, Burns JC, Bastian J, Chung KJ, Colan SD, Duffy CE, Fulton DR, Glode MP. A single intravenous infusion of gamma globulin as compared with four infusions in the treatment of acute Kawasaki syndrome.. The New England journal of medicine. 1991; 324 (23): p.1633-9.doi: 10.1056/NEJM199106063242305 . | Open in Read by QxMD
  11. Newburger JW, Takahashi M, Burns JC, Beiser AS, Chung KJ, Duffy CE, Glode MP, Mason WH, Reddy V, Sanders SP. The treatment of Kawasaki syndrome with intravenous gamma globulin.. The New England journal of medicine. 1986; 315 (6): p.341-7.doi: 10.1056/NEJM198608073150601 . | Open in Read by QxMD
  12. Harada M, Yokouchi Y, Oharaseki T, et al. Histopathological characteristics of myocarditis in acute-phase Kawasaki disease.. Histopathology. 2012; 61 (6): p.1156-67.doi: 10.1111/j.1365-2559.2012.04332.x . | Open in Read by QxMD
  13. Gordon JB, Kahn AM, Burns JC. When children with Kawasaki disease grow up: Myocardial and vascular complications in adulthood.. J Am Coll Cardiol. 2009; 54 (21): p.1911-20.doi: 10.1016/j.jacc.2009.04.102 . | Open in Read by QxMD
  14. Bonnet M, Champagnac A, Lantelme P, Harbaoui B. Endomyocardial biopsy findings in Kawasaki-like disease associated with SARS-CoV-2. Eur Heart J. 2020; 41 (39): p.3863-3864.doi: 10.1093/eurheartj/ehaa588 . | Open in Read by QxMD
  15. Hinton RB, Ware SM. Heart Failure in Pediatric Patients With Congenital Heart Disease.. Circ Res. 2017; 120 (6): p.978-994.doi: 10.1161/CIRCRESAHA.116.308996 . | Open in Read by QxMD

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