# Kawasaki disease - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: Kawasaki Disease - StatPearls (NCBI Bookshelf NBK537163) - https://www.ncbi.nlm.nih.gov/books/NBK537163/ · Kawasaki disease - disease-level clinical article (kawasaki-disease-full.txt) · Kawasaki disease - disease-level clinical article (kawasaki-disease-clinical.txt) · Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph, p111) - Verified date: 2026-08 ## Verified against - Kawasaki Disease - StatPearls (NCBI Bookshelf NBK537163) - https://www.ncbi.nlm.nih.gov/books/NBK537163/ - Kawasaki disease - disease-level clinical article (kawasaki-disease-full.txt) - Kawasaki disease - disease-level clinical article (kawasaki-disease-clinical.txt) - Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph, p111) ## Treatment metadata - Immunoglobulin — injection - Acetylsalicylic acid — 75 mg — oral.solid - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text KAWASAKI DISEASE Sources: Kawasaki Disease - StatPearls (NCBI Bookshelf NBK537163) - https://www.ncbi.nlm.nih.gov/books/NBK537163/ · Kawasaki disease - disease-level clinical article (kawasaki-disease-full.txt) · Kawasaki disease - disease-level clinical article (kawasaki-disease-clinical.txt) · Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph, p111) Review status: REVIEWED against 4 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (8) - Presentation is multiple days of fever with generalized malaise [fever · malaise] - Any diagnostic criterion counts toward the diagnosis if it occurred at any point in the illness, even if not present at the current visit - Untreated, the high fever of the acute phase can persist up to 3 to 4 weeks instead of the usual 1 to 2 [fever] - Less common features include abdominal pain, vomiting, or diarrhea in about 20%, plus hepatitis, parotitis, intussusception, and joint pain in 15-50% affecting mainly large weight- bearing joints [abdominal pain · diarrhoea · joint pain · vomiting] - Other reported features include headache, irritability, seizures, and aseptic meningitis, plus rhinorrhea/cough in roughly a quarter of cases, aortic aneurysm, valvular insufficiency, and epididymitis, orchitis, or urethritis [cough · headache · irritability · runny nose · seizures] - Fever must last five days or more, with at least four of the five major clinical criteria present, either together or over several days [fever] - Incomplete Kawasaki disease should be considered when a child has fever for 5 or more days with only 2 to 3 major criteria; this pattern shows up more often at the youngest and oldest ends of childhood [fever] - In infants under 6 months, a fever lasting more than 7 days warrants an echocardiogram to rule out Kawasaki disease [fever] SIGNS - what you find (11) - The fever responds poorly to antipyretics and usually stays above 38.5 C [fever] - Conjunctival injection can come with light sensitivity and correlates with uveitis in about 65% of cases [eye redness · photophobia] - Purulent conjunctivitis or exudative pharyngitis point away from Kawasaki disease toward another diagnosis [pus] - Bilateral conjunctival injection is painless and without discharge [eye redness] - Oral findings include red mouth and throat, strawberry tongue, or red cracked lips - Rash is polymorphous - can be morbilliform, maculopapular, or scarlatiniform [rash] - Hands and feet swell with redness of the palms and soles [redness] - Cervical lymph nodes enlarge to over 1.5 cm across - The trunk and limb rash appears within 5 days of fever onset, mimics a viral or drug rash, but is not itchy [fever · rash] - Peeling of the skin around the nails starts about 2 to 3 weeks after fever onset and is a hallmark of the disease [fever] - Beau's lines (transverse nail depressions) show up in over 75% of patients, appearing 5-8 days after fever onset and lasting 2-4 weeks [fever] TESTS (12) - CRP under 30 mg/L and ESR under 40 mm/hr in suspected incomplete KD means daily follow-up rather than immediate imaging, with echocardiogram once fever resolves and skin peels - CRP over 30 mg/L or ESR over 40 mm/hr in suspected incomplete KD prompts an echocardiogram right away - Incomplete KD lab criteria (need more than 3): low hemoglobin for age, high WBC, high platelets, low albumin, raised ALT, and high urine WBC - No labs or imaging are required once KD is diagnosed clinically, except an echocardiogram - Mild-to-moderate normocytic anemia marks the acute phase, while high platelets mark the subacute phase - Low platelets in the acute phase are less common but predict a higher risk of coronary artery aneurysm - Urinalysis typically shows sterile pyuria, which disappears if the sample is taken by bladder aspiration - A lumbar puncture, if done, commonly shows pleocytosis in KD, which can be mistaken for viral meningitis - Blood culture, stool culture, ANA, rheumatoid factor, and ASO titers should all come back negative in true KD - An echocardiogram during the acute phase screens for coronary artery aneurysm - most often affecting the right coronary artery and the proximal left anterior descending vessel - Fusiform, small, distal aneurysms are the ones most likely to regress - Findings on ECG can include a lengthened PR interval, deep Q waves, reduced voltage, ST-T abnormalities, and arrhythmias - all pointing to myocardial involvement IF NOT THIS - what else fits (7) - Infections that can mimic Kawasaki disease include preseptal cellulitis, peritonsillar or retropharyngeal abscess, cervical lymphadenitis, group A strep, adenovirus, enterovirus, parvovirus B19, measles, mononucleosis, and scarlet fever - The infectious mimic list also includes leptospirosis, Lyme disease, toxic epidermal necrolysis, staph scalded skin syndrome, Rocky Mountain spotted fever, meningitis, toxic shock syndrome, and rheumatic fever - Adenovirus causes conjunctival discharge, which Kawasaki disease characteristically lacks - Bilateral vs unilateral lymphadenopathy separates the two - Kawasaki is unilateral in over half of cases, unlike lymphadenitis - True retropharyngeal abscess has clinical symptoms and abnormal imaging, whereas the retropharyngeal edema of Kawasaki disease does not - Unlike Kawasaki disease, toxic shock syndrome and scarlet fever spare the eyes and joints - Lupus, infantile polyarteritis nodosa, juvenile idiopathic arthritis, and drug hypersensitivity reactions can look similar but lack the classic criteria, differing in chronicity and joint count Source Kawasaki disease - disease-level clinical article (kawasaki-disease-full.txt) Status traced to the source above Rx: Immunoglobulin | Antiplatelet and anti-inflammatory | Main treatment IMMUNOGLOBULIN 1. IMMUNOGLOBULIN [1st line] Adult Not applicable - Kawasaki disease is a disease of childhood (see the paediatric dose) - A single infusion Peds 2 g/kg as a single intravenous infusion over 10 to 12 hours. It is written as grams per kilogram rather than as a milligram grid because that is how the article states it and how the infusion is prescribed; the article states no maximum, so none is given here. Source Kawasaki Disease - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK537163/ Why The cited article states that patients should receive high-dose intravenous immunoglobulin at 2 g/kg over 10 to 12 hours together with high-dose aspirin. This is the treatment that prevents the coronary artery aneurysms the disease is feared for, and it is given in hospital - the decision a GP makes is to suspect the diagnosis and send the child in, early enough for it to be given. Caution THIS IS AN ADMISSION, NOT A PRESCRIPTION. It is a hospital infusion. What primary care contributes is suspecting Kawasaki disease early enough for it to be given inside the window in which it protects the coronary arteries. GIVE IT WITH ASPIRIN, NOT INSTEAD OF IT. The article names the two together as the treatment. THE ARTICLE RAISES A HARM AT THE HIGHER DOSE: concern that 4 g/kg rather than 2 g/kg causes haemolytic anaemia, with children who had complete Kawasaki disease, were resistant to immunoglobulin, and had non-O blood groups most at risk. WHAT THE ARTICLE NAMES FOR RESISTANT DISEASE, and it is a specialist decision, not a primary-care one: infliximab 5 mg/kg or cyclophosphamide as alternatives, and extended prednisolone 2 mg/kg/day for 4 to 5 weeks in children at high risk of resistance, from the 2012 RAISE trial - it also records that research results have been inconsistent. The Egyptian formulary chapters held here carry no immunoglobulin monograph, so this dose comes from the article alone and the article is named on the row. Egypt Y-GLOBULIN KGCC I.M VIAL KORIA GREEN C... 37.00 EGP I.V-GLOBULIN 50MG/ML 0.5G VIAL KORIA GREEN C... 360.00 EGP INTRAGLOBIN F 50MG/ML (20ML=1G) I.V.INFUSION BIOTEST PHARMA GERMANY > EG... 600.00 EGP INTRAGLOBIN F 50MG/ML (50ML=2.5G) I.V.INFUSION BIOTEST PHARMA GERMANY > ... 1450.00 EGP VIGAM-S 5 %W/V (100ML) INJ. BPL BIO PRO... 2200.00 EGP GAMUNEX-C 10% I.V. VIAL 100 ML GRIFOLS THERA... 6000.00 EGP GAMUNEX-C 10% I.V. VIAL 25 ML GRIFOLS THERA... 10000.00 EGP GAMUNEX-C 10% I.V. VIAL 50 ML GRIFOLS THERA... 20000.00 EGP ANTIPLATELET AND ANTI-INFLAMMATORY 2. ACETYLSALICYLIC ACID [1st line] Adult Not applicable - Kawasaki disease is a disease of childhood (see the paediatric dose) - Two phases: until afebrile, then 6 to 8 weeks Peds Neonate: 8 mg/kg four times a day for 2 weeks or until afebrile, then 5 mg/kg once daily for 6 to 8 weeks. If there is no evidence of coronary lesions after 8 weeks, stop or seek expert advice. 1 month to 11 years: 7.5 to 12.5 mg/kg four times a day for 2 weeks or until afebrile, then 2 to 5 mg/kg once daily for 6 to 8 weeks. If there is no evidence of coronary lesions after 8 weeks, stop or seek expert advice. (Formulary schedule, oral, in two phases. Neonate: 8 mg/kg four times a day for 2 weeks or until afebrile, then 5 mg/kg once daily for 6 to 8 weeks. Child 1 month to 11 years: 7.5 to 12.5 mg/kg four times a day for 2 weeks or until afebrile, then 2 to 5 mg/kg once daily for 6 to 8 weeks. In both, if there is no evidence of coronary lesions after 8 weeks, stop or seek expert advice.) Source Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph, p111) Why The cited article names high-dose aspirin alongside immunoglobulin as the treatment, dropped to a low antiplatelet dose once the child has been afebrile for over 48 hours and continued until there is no evidence of cardiac change, about 6 to 8 weeks after onset. The Egyptian formulary names Kawasaki disease among the paediatric indications for acetylsalicylic acid and gives the age-banded schedule used here. Caution THE TWO NAMED SOURCES DO NOT AGREE ON THE HIGH-DOSE PHASE, AND BOTH ARE GIVEN HERE RATHER THAN ONE BEING QUIETLY PREFERRED. The Egyptian formulary's Kawasaki band is 7.5 to 12.5 mg/kg four times a day, which is 30 to 50 mg/kg a day. The article says 80 to 100 mg/kg a day divided every six hours until afebrile for over 48 hours, then 3 to 5 mg/kg. The formulary's figures are printed above because it is the Egyptian formulary and its band is written for this disease by age; the article's higher figure is recorded here so the difference is visible rather than hidden. THIS IS THE ONE DISEASE WHERE A CHILD IS GIVEN ASPIRIN ON PURPOSE. The formulary's general rule still stands beside it: do not use aspirin under 18 in a child who has or is recovering from chickenpox or influenza-like illness, because of Reye's syndrome, and give it under 16 only on a doctor's advice. IT IS STARTED IN HOSPITAL. Both phases run alongside the immunoglobulin infusion and the echocardiography that decides when it stops. Do not give in hypersensitivity to NSAIDs, in asthma with rhinitis and nasal polyps, or in active peptic ulceration. Egypt AGGREX 75MG 60 TABS. RAMEDA 33.00 EGP (0.55/unit) ASPOCID 75MG 20 TAB. CID 22.00 EGP (1.10/unit) ASPOCID 75MG 30 TAB. CID 33.00 EGP (1.10/unit) ASPIRIN-CHEMIPHARM 75 MG 30 CHEW.TABS. CHEMIPHARM 12.00 EGP RIVO 75 MG 30 CHEW. TABS. ARAB DRUG COM... 21.00 EGP ASPOCID PAEDIATRIC 75MG 30 CHEW. TABS. CID 35.00 EGP EZACARD 75 MG 30 E.C. TABS. MULTI-APEX 51.00 EGP MAIN TREATMENT 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Kawasaki Disease - StatPearls (NCBI Bookshelf NBK537163) - https://www.ncbi.nlm.nih.gov/books/NBK537163/ Why Kawasaki disease is treated in hospital with intravenous immunoglobulin and aspirin, and the whole primary-care task is to recognise it early enough for that to work. Both are set out above so the referral is an informed one - neither is started in a clinic, and nothing given in a clinic alters the coronary risk. Caution THE TRIGGER IS FIVE DAYS OF FEVER - the article's mnemonic opens on fever lasting more than 5 days. The fever is the most consistent feature, it barely answers antipyretics, and it usually sits above 38.5 degrees Celsius. A child whose fever shrugs off paracetamol for five days is the child to think of Kawasaki in. THE FIVE OTHER FEATURES - conjunctivitis with no exudate. Rash. Hands or feet swollen or red, then peeling, with changes in the nails. Adenopathy, often on one side, a cervical node bigger than 1.5 cm. And the mouth: red mucosa, lips fissured or crusted, or a strawberry tongue. ASK ABOUT FEATURES THAT HAVE ALREADY GONE - these features tend to arrive one after another rather than all together, and that sequence is what points to Kawasaki rather than the other diagnoses on the list. The red eyes may have settled by the day the child reaches the clinic. AN INFANT CAN HAVE KAWASAKI WITH ALMOST NOTHING ELSE - consider incomplete Kawasaki disease in a child with fever of five days or more and only two or three major criteria present; it is commoner in the younger infants and in the older children. So where an infant under 6 months has had a fever running over 7 days, get an echocardiogram to rule Kawasaki out. WHY THE DELAY COSTS THE HEART - IVIG ideally goes in within 7-10 days of the fever starting, to head off cardiac complications; given in that window it brings coronary artery aneurysm down from 25% to 3-5%. Referral inside that window is the entire clinical value of recognising Kawasaki disease. AND THE LONGER THE FEVER RUNS, THE WORSE THE ODDS - top of the article's list of risks for coronary artery aneurysm is fever lasting more than 8 days, which it calls the most important risk factor of all. Next on that list: fever coming back after the child has been afebrile for 48 hours. TREATMENT IS INPATIENT AND INTRAVENOUS - high-dose IVIG, 2 g/kg run over 10-12 hours, and aspirin (ASA) in high dose too: 80 to 100 mg/kg/day, divided six-hourly, carried on until the child has been afebrile more than 48 hours. Those are hospital numbers, printed so a family can be told what is coming, and not a primary-care prescription. DO NOT START ASPIRIN IN A FEBRILE CHILD IN THE CLINIC - the same article warns that a child on ASA who catches influenza or varicella runs a higher risk of Reye syndrome. It adds a second worry: in the acute phase, low albumin, slow gastric transit and high renal clearance mean toxic effects can appear at lower doses than expected. WHAT IS AT STAKE IF IT IS MISSED - untreated, about 15-25% of children go on to develop coronary artery aneurysms. And every death from Kawasaki is essentially a cardiac one, typically falling 15-45 days after the fever began. AGE SHIFTS THE PROGNOSIS BOTH WAYS - children diagnosed between 6 months and 9 years do better than the younger and the older, perhaps because the classic picture brings them in sooner. VACCINES AFTER TREATMENT NEED A GAP - IVIG can stop a vaccine taking, so a routine vaccine such as MMR may have to be put back. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)