Clinical Features

• Clinical diagnosis requires fever for at least 5 days and one of the following: ≥ 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

    • Erythema and swelling of the tongue (strawberry tongue)

    • Cracked and red lips

  • Cervical lymphadenopathy (mostly unilateral)

Nonspecific symptoms may precede the onset of Kawasaki disease (e.g., diarrhea, fatigue, abdominal pain, arthritis, hoarseness, breathing difficulties)

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.