A 4 year old boy presents with the above findings. What is it and how do you treat it?

Classic Kawasaki is diagnosed by fever for greater than 5 days plus 4 out of 5 classic signs.

  • Mnemonic: “CRASH and burn”
  • Conjunctivitis (bilateral and nonexudative)
  • Rash (polymorphous, ie can look like anything)
  • Adenopathy (cervical, usually greater than 1.5cm and usually unilateral)
  • Strawberry tongue or other oral changes (lip swelling/fissuring/erythema/bleeding, oropharyngeal hyperemia)
  • Hands and feet (induration and erythema, desquamation is a late sign)
  • Burn = fever lasting for >5 days

What about a child that presents with fever for 6 days but only has 3 out of the 5 criteria??

Check  ESR and CRP.

Incomplete Kawasaki is defined as fever for >5 days with 2 or more of the classic findings plus elevated ESR (>40mm/hr) and CRP (>3.0mg/dL).  It is most common in infants under 12 months of age.

If ESR and CRP are elevated, the pt needs an echo to evaluate for coronary artery aneurysms.

If the echo is normal, follow up in 24-48 hours and will need a repeat echo if fever persists.

TREAT kids with IVIG and aspirin (admit) if echo is positive, or with normal echo and the presence of 3 or more supplemental criteria:

  • Anemia
  • Elevated ALT
  • Albumin<3.0mg/dL,
  • Sterile Pyuria (>10 WBC/hpf)
  • Platelets >450K
  • WBC >15,000


1) Trager J. Kawasaki Disease. Images in Clinical medicine. New England Journal Medicine. Nov 1995; 333:1391
2) Falcini F, Capannini S, Rigante D. Kawasaki syndrome: an intriguing disease with numerous unsolved dilemmas. Pediatric Rheumatology 2011;9:17
3) American Academy of Pediatrics. Kawasaki Disease. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed.
July 2024