Kawasaki disease (KD) is the most common form of acquired heart disease in children in industrialized nations KD is a clinical diagnosis in a child with fever to 102°F for at least days who has four of five additional symptoms: oral mucosal changes; rash; nonpurulent conjunctivitis; extremity changes; and cervical lymphadenopathy Incomplete KD, where children not meet all the diagnostic criteria, is more common in young infants, and is a risk factor for the development of coronary artery aneurysms (CAAs) Current Evidence KD is a vasculitic condition of unknown etiology that can cause CAAs or ectasia in up to 25% of untreated children It is the most common form of acquired heart disease in American children While first described in Japanese children, it occurs in children of all races and ethnicities and is most common in infants and preschoolaged children Older children are also at risk for CAA, as diagnosis is often delayed in this group Goals of Treatment The goal of treatment is to recognize and initiate treatment in children with KD before the 10th day of symptoms, as delayed treatment increases the risk of CAA development Clinical Considerations Clinical recognition: The symptoms of KD are summarized in Table 94.15 Incomplete KD, in which a child does not meet all diagnostic criteria, is more common in infants and rates of CAA are higher in children with incomplete KD It is important that clinicians ask all caregivers of children with fever of at least days duration about KD symptoms Not all symptoms may be present at the time of ED presentation The differential diagnosis of KD is extensive and includes viral infections (especially adenovirus, but can also include EBV, cytomegalovirus [CMV]), scarlet fever, staphylococcal-scalded skin syndrome, TSS, rickettsial diseases (e.g., RMSF), leptospirosis, drug hypersensitivity reactions, and some rheumatologic conditions Triage considerations: Children with KD can be intravascularly depleted from insensible losses from several days of high fever Fluid resuscitation may be needed in the ED If there is concern for cardiac function based upon examination (e.g., murmur, hepatomegaly), fluid resuscitation should proceed cautiously and early cardiac imaging (or a baseline electrocardiogram) should be obtained