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Kawasaki disease

Last reviewed: 4 Sep 2023
Last updated: 14 Dec 2022



History and exam

Key diagnostic factors

  • polymorphous rash
  • conjunctival injection
  • mucositis
  • skin changes in the peripheral extremities
  • enlarged cervical lymph nodes
  • coronary artery aneurysms
  • fever and extreme irritability
More key diagnostic factors

Other diagnostic factors

  • pericarditis with effusion
  • congestive heart failure
  • joint pain or edema
  • neurologic manifestations
  • gastrointestinal manifestations
  • urologic manifestations
  • other dermatologic manifestations
Other diagnostic factors

Risk factors

  • Asian ancestry
  • age 3 months to 4 years
  • male sex
More risk factors

Diagnostic investigations

1st investigations to order

  • CBC
  • erythrocyte sedimentation rate (ESR)
  • CRP
  • echocardiogram
More 1st investigations to order

Investigations to consider

  • serum LFTs
  • urinalysis
  • chest x-ray
  • electrocardiogram
  • ultrasonography of the gallbladder
  • ultrasonography of the testes
  • lumbar puncture
  • magnetic resonance angiography
  • cardiac catheterization and angiography
  • natriuretic peptide tests
More investigations to consider

Treatment algorithm


presentation ≤10 days from onset; or presentation >10 days from onset with evidence of ongoing inflammation

presentation >10 days from onset without evidence of ongoing inflammation


after initial episode: Z score always <2; no involvement at any time

after initial episode: Z score ≥2.0 to <2.5; dilation only

after initial episode: Z score ≥2.5 to <5.0; small aneurysm

after initial episode: Z score ≥5 to <10 (with absolute luminal dimension <8 mm); medium aneurysm

after initial episode: Z score ≥10 or absolute luminal diameter ≥8 mm; large or giant aneurysm



Paul Brogan, BSc(Hon), MBChB(Hon), FRCPCH, MSc, PhD

Professor of vasculitis

University College London




PB is co-chief investigator of the KDCAAP trial, and is an author of several references cited in this topic.

Kirsty McLellan, BMedSci, MBChB, MRCPCH

Specialist Registrar in Paediatric Rheumatology

Great Ormond Street Hospital




KM declares she has no competing interests.


Dr Paul Brogan and Dr Kirsty McLellan would like to gratefully acknowledge Professor Abraham Gedalia and Dr James Krulisky, previous contributors to this topic.


AG declares that he has no competing interests. JK declares that he is a paid consultant for Axia Medical Solutions, a small skincare company from Carlsbad, CA.

Peer reviewers

Michael Levin, null

Professor of International Child Health

Imperial College London



ML declares that he has no competing interests

Russell W. Steele, MD

Editor in Chief

Journal of Clinical Pediatrics

Department of Pediatrics

Division of Infectious Diseases

Ochsner Children's Health Center

New Orleans



RWS declares that he has no competing interests.

John L. Ey, MD

Clinical Professor of Pediatrics

Department of Pediatrics

Oregon Health Science University




JLE declares that he has no competing interests.

David Burgner, BSc(Hons), MBChB, MRCP, MRCPCH, FRACP, DTMH, PhD

Principal Research Fellow

Murdoch Childrens Research Institute

The Royal Children’s Hospital




DB has received competitive research funding from the National Heart Foundation Australia and from the Agency for Science, Technology and Research of the Singapore Government. He is co-inventor on a patent related to diagnostics submitted through the Genome Institute of Singapore.

  • Kawasaki disease images
  • Differentials

    • Staphylococcal or streptococcal infection
    • Systemic juvenile idiopathic arthritis (systemic JIA)
    • Scarlet fever
    More Differentials
  • Guidelines

    • Guideline for the management of Kawasaki disease
    • European consensus-based recommendations for the diagnosis and treatment of Kawasaki disease - the SHARE initiative
    More Guidelines
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