Kawasaki disease

Kawasaki disease is a small to medium vessel vasculitis predominantly affecting young children. It can affect any body organ but there is a predilection for the coronary vessels.

Japan has the highest incidence in the world, with an annual incidence of 300/100,000 children under the age of four years 10. Worldwide, it is the commonest vasculitis in children 9. It is slightly more common is males, M:F, 1.4:1 10.

It is more common in siblings, ~3% siblings will be diagnosed with Kawasaki, this equates to a ten-fold increased risk in a sibling. It is also more likely in children of affected parents, although no genetic link has been identified 10.

In the United States, it is most commonly seen in children of Asian ethnicity, in particular Japanese, but less commonly in African americans and least commonly in Caucasians.

Persistent fever is the commonest way with which most children present. The specific signs and symptoms vary with the stage of disease:

  • fever that is refractory to antibiotics
  • general malaise and irritability
  • non-exudative conjunctivitis (90%)
  • anterior uveitis (70%)
  • perianal erythema (70%)
  • lymphadenitis (75%)
  • strawberry tongue
  • desquamation of the digits
  • thrombocytosis
  • coronary aneurysms
  • highest risk of death
  • clinical symptoms and signs recede
  • persistence of any cardiac complications into adulthood

An autoimmune aetiology has been postulated. It is generally self-limiting but acute fatalities are thought to occur in ~1% of cases. The most concerning morbidity is due to coronary involvement where it can manifest as a myocarditis with coronary arterial aneurysm formation 1,2,4.

Chest radiographs can be normal. Abnormal findings are non-specific and include a reticulogranular pattern, peribronchial cuffing, pleural effusion, atelectasis and/or air trapping 1.

Rarely, a few years after resolution of the initial episode, the patient may present with calcified coronary artery aneurysms visible on the chest x-ray 8. Although rare, this is an Aunt Minnie presentation of Kawasaki disease sequelae in older patients.

May show small coronary arterial ectasias, aneurysms or stenoses. Angiography is the most sensitive and specific for vascular assessment 4.

Useful in assessing myocardial perfusion, wall thinning and aneurysms.

It is named after the Japanese paediatrician Tomisaku Kawasaki (1925-fl. 2017) 9 who saw his first case in 1961 and initially described it in a case series of 50 children in 1967 7,9.

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Article information

rID: 7431
Synonyms or Alternate Spellings:
  • Kawasaki disease
  • Mucocutaneous lymph node syndrome
  • Kawasaki disease (KD)
  • Kawasaki's disease

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Cases and figures

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    Case 1: with RCA and LAD aneurysms
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