Diagnostic Criteria for Kawasaki Syndrome

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Presence of fever for at least 5 days, 4 of the 5 criteria below, and lack of another known disease process to cause the illness:

1. Bilateral conjunctival injection

2. Changes of the mucous membranes of the upper respiratory tract: injected pharynx; injected, fissured lips; strawberry tongue

3. Polymorphous rash

4. Changes of the extremities: peripheral edema, peripheral erythema, periungual desquamation

5. Cervical adenopathy

Strict use of these criteria will miss cases of Kawasaki disease, so-called "atypical" or "incomplete" Kawasaki disease. These are patients in whom coronary arteritis is present, in association with persistent fever, and fewer than four other diagnostic criteria. Vigilance for these cases is mandated because of the potential for disastrous consequences in untreated coronary arteritis. In cases of suspected Kawasaki disease, imaging of the coronary vessels is indicated. In young children, trans-thoracic echocardiography can be used to diagnose coronary artery changes with high specificity, but in older children and in adults, visualization of the vessels is more difficult. Coronary X-ray angiography has been the

Kawasaki Exanthem

Figure 36.3. Acral edema and erythema. Courtesy of Nancy Figure 36.4. Morbilliform exanthem. Courtesy of Nancy

Esterly, MD.

Esterly, MD.

Figure 36.3. Acral edema and erythema. Courtesy of Nancy Figure 36.4. Morbilliform exanthem. Courtesy of Nancy

Esterly, MD.

Esterly, MD.

Morbilliform
Figure 36.5. Inguinal and genital accentuation of exanthem with minute pustules. Courtesy of Nancy Esterly, MD.

mainstay of evaluation. However, recently, magnetic resonance angiography has been shown to be comparable to X-ray angiography, and is likely to become the future standard for evaluation of coronary abnormalities in older children and in adults (9). Laboratory findings may include elevated erythrocyte sedimentation rate and C-reactive protein, leukocytosis with left shift, pyuria, proteinuria, or anemia. In cases of suspected Kawasaki disease, a suggested diagnostic evaluation is given.

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