Kawasaki disease is also known as mucocutaneous lymph node syndrome. It is an acute systemic vasculitis predominantly affecting medium-sized arteries, especially the coronary arteries. It affects young children, typically under 5 years. There is no clear cause or trigger.
It is more common in Asian children, particularly Japanese and Korean, but can occur in any ethnicity. It is also more common in boys. The key complication is coronary artery aneurysm.
Clinical Features
Persistent high fever for more than 5 days is a key presenting feature, along with general malaise.
The key skin findings are:
- Widespread erythematous maculopapular rash
- Erythema and swelling of the hands and feet
- Desquamation (skin peeling) on the palms and soles (later in the condition)
Other features include:
- Strawberry tongue (red tongue with large papillae)
- Cracked lips
- Cervical lymphadenopathy
- Bilateral non-purulent conjunctivitis
TOM TIP: Think of Kawasaki disease in any child presenting with a high fever for more than 5 days. A rash, strawberry tongue, lymphadenopathy and conjunctivitis are characteristic features worth remembering.
Investigations
Investigations in Kawasaki disease include:
- Full blood count may show anaemia, leukocytosis and thrombocytosis
- Liver function tests may show hypoalbuminemia and elevated liver enzymes
- Inflammatory markers (ESR and CRP) are raised
- Urinalysis may show raised white blood cells (without infection)
- Echocardiogram may demonstrate coronary artery pathology
Phases
The acute phase involves an unwell child with a fever, rash and lymphadenopathy. This typically lasts 1-2 weeks.
The subacute phase occurs as the acute symptoms settle. This phase involves skin desquamation and arthralgia, and there is a risk of coronary artery aneurysms forming. This typically lasts 2 – 4 weeks.
The convalescent stage occurs as the remaining symptoms settle and the blood tests slowly return to normal. The coronary aneurysms may regress. This typically lasts 4 weeks or more.
Management
The key treatments for Kawasaki disease are:
- High-dose aspirin as an anti-inflammatory and to reduce the risk of thrombosis
- IV immunoglobulins to reduce the risk of coronary artery aneurysms
Patients are followed up with serial echocardiograms to monitor for evidence of coronary artery aneurysms.
TOM TIP: Kawasaki disease is one of the few conditions in which aspirin is used in children. Aspirin is usually avoided due to the risk of Reye’s syndrome.
Last updated August 2026
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