UMEM Educational Pearls

Most of us are at least vaguely familiar with Kawasaki Syndrome as an acute vasculitis of small and medium-sized vessels, predominantly occurring in patients aged 6 months to 5 years.

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

But what about an 8 month-old with 6 days of fever plus nonexudative conjunctivitis, unilateral cervical adenopathy and a diffuse maculopapular rash?   Send some labs!

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. 

Disposition for the 8 month-old?

  • If ESR and CRP are not elevated, discharge to home with f/u in 24 hours to re-evaluate symptoms and for repeat labs if fever persists.
  • If ESR and CRP are elevated, the child 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 (which generally means admission) if echo is positive, or with normal echo and the presence of 3 or more supplemental criteria:

  • Anemia for age
  • Elevated ALT
  • Albumin<3.0mg/dL,
  • Sterile Pyuria (>10 WBC/hpf)
  • Platelets >450K after 7 days
  • WBC >15,000
1) Falcini F, Capannini S, Rigante D. Kawasaki syndrome: an intriguing disease with numerous unsolved dilemmas. Pediatric Rheumatology 2011;9:17
2) 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. Elk Grove Village, IL: American Academy of Pediatrics; 2009. 


1111251332_2009_Red_Book.doc (384 Kb)