Controversies in diagnosis and management of Kawasaki disease

Table 1 American Heart Association guidelines for diagnosis of Kawasaki disease (2017)[13]

Classic KD is diagnosed with fever persisting for least 5 d
At least four of the five principal clinical features:
Changes in lips and oral cavity: Erythema, lips cracking, strawberry tongue, diffuse injection of oral and pharyngeal mucosae
Changes in extremities
Acute: Erythema of palms, soles; edema of hands, feet
Subacute: Periungual peeling of fingers and toes in weeks 2 and 3
Polymorphous exanthema (diffuse maculopapular, urticarial, erythroderma, erythema-multiforme like, not vesicular or bullous)
Bilateral bulbar conjunctival injection without exudates
Cervical lymphadenopathy (> 1.5 cm diameter), usually unilateral
A careful history may reveal that ≥ 1 principal clinical features were present during the illness but resolved by the time of presentation
Exclusion of other diseases with similar findings (e.g., scarlet fever, viral infections like measles, adenovirus, enterovirus, Stevens-Johnson syndrome, toxic shock syndrome, drug hypersensitivity reactions, systemic juvenile idiopathic arthritis)

KD: Kawasaki disease.