Kawasaki Disease — Diagnosis & Treatment Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Meets Kawasaki disease?
   Fever ≥5 days — does it meet Kawasaki disease? (Complete: fever ≥5 days + ≥4 principal features (bilateral non-exudative conjunctival injection; oral/lip changes [strawberry tongue]; polymorphous rash; extremity changes [hand/foot erythema-edema / periungual desquamation in convalescence]; cervical lymphadenopathy ≥1.5 cm, usually unilateral). With all 5, can diagnose on day 4. Incomplete: fever ≥5 days + 2–3 features + labs (CRP ≥3.0 mg/dL, raised ESR and supplementary criteria) or coronary abnormality on echo.)
   • Meets complete/incomplete → Diagnosed → IVIG + aspirin
   • Does not meet it → Does not meet it
2. [End] Does not meet it
   Evaluate other causes of fever with rash (infection, other vasculitides, drug eruption, etc.); prolonged unexplained fever in infants needs labs and re-evaluation, with echo for coronary arteries if needed.
3. [End] Diagnosed → IVIG + aspirin
   Ideally within 10 days of onset: 1) IVIG 2 g/kg as a single infusion (reduces coronary aneurysm risk from 15–25% to ~5%). 2) Aspirin: high-dose in the acute phase (per regional protocol, e.g. 30–50 or 80–100 mg/kg/day divided), switching to low-dose 3–5 mg/kg/day antiplatelet after defervescence, continued until follow-up echo is normal or longer. 3) Echo for coronary arteries (do not delay treatment for the echo), graded by z-score. 4) IVIG resistance (persistent/recurrent fever ~36 h after completion) → a second IVIG dose ± corticosteroids ± infliximab. Patients presenting >10 days with ongoing inflammation/coronary abnormality should still be treated.

Source guidelines & references

• AHA scientific statement on diagnosis, treatment and long-term management of Kawasaki disease. Circulation 2017

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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