ABSTRACT
CLINICAL FEATURES Acute Illness The onset is typically abrupt with the sudden occurrence of high fever which is followed in 1-3 days by the appearance of the diagnostic clinical features described by Dr. Kawasaki (Table 1). By day 5 of illness, the feverish child with the typical course presents a striking picture: the conjunctivae show discrete vascular injection; the lips are reddened, cracked, and often scabbed or bleeding; there is a dramatic bright red rash which may take multiple forms; and the hands and feet are swollen and tender with a diffuse red to purple discoloration of the palms and soles. Approximately 50% of the patients have marked enlargement of cervical lymph nodes which are often tender and erythematous but which do not suppurate. The associated features of the illness attest to the multisystem involvement (Table 2). Despite the involvement of mucous membranes, joints, liver, and the gastrointestinal system, the only severe or permanent damage occurs in the cardiovascular system. Kawasaki syndrome is basically self-limited
Table 1 Principal Diagnostic Criteria for Kawasaki Syndrome
Five of the six criteria are required to mJJke a secure diagnosis: Fever Conjunctival injection Changes in the mouth
erythema, fissuring and crusting of lips diffuse oropharyngeal erythema strawberry tongue
Changes in the peripheral extremities Induration of the hands and feet Erythema of the palms and soles Desquamation of the finger and toe tips 2 weeks after onset
Me/Ish
with the resolution of the acute inflammatory symptoms and laboratory abnormalities within a 3-month period. Damage sustained by the cardiovascular system during the acute phase may be persistent and able to cause problems in later life.
