Children and adolescents
Kawasaki disease
Fever for 5 days or more with conjunctivitis, oral changes, rash, extremity changes or cervical nodes. Treat early to protect the coronaries.
What to look for
- Fever for 5 days or more plus 4 or more of: bilateral non-exudative conjunctival injection, red cracked lips or strawberry tongue, polymorphous rash, hand and foot erythema or edema (later peeling), cervical node over 1.5 cm
- Incomplete Kawasaki disease (fewer features) is common in infants. Use the AHA algorithm with CRP, ESR and supplemental labs.
What to do
- Send to the emergency department or admit.
- IVIG 2 g/kg as soon as possible after diagnosis, ideally within 10 days of fever onset, plus aspirin. IVIG is still indicated after day 10 if inflammation persists.
- Get an echocardiogram at diagnosis and at follow-up.
- High-risk patients may need added treatment (glucocorticoids, infliximab), per the AHA 2024 update.
About this urgency level
Call rheumatology directly. Many of these need the emergency department or admission, and treatment often starts before the specialist visit.
Timeframes are typical targets. Local pathways, capacity and clinical judgment come first.