# Kawasaki Disease

> Kawasaki disease for NEET-PG Paediatrics: diagnostic criteria, coronary aneurysm risk, IVIG 2 g/kg and aspirin therapy in exam-ready notes.

- Canonical URL: https://prepelephant.com/topics/neet-pg/paediatrics/kawasaki-disease
- Exam / course: NEET-PG · Subject: Paediatrics
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Kawasaki Disease", PrepElephant, https://prepelephant.com/topics/neet-pg/paediatrics/kawasaki-disease

## Direct answer

Kawasaki disease is an acute, self-limited systemic vasculitis of medium-sized arteries, chiefly of children under five years, whose importance is coronary artery aneurysm — the leading acquired heart disease of children. Diagnosis requires fever of five days or more with at least four of five features: bilateral non-exudative conjunctival injection, oral mucosal changes, peripheral extremity changes, polymorphous rash and cervical lymphadenopathy. Treatment is a single 2 g/kg intravenous immunoglobulin infusion with aspirin, ideally within the first ten days, which sharply reduces coronary complications.

## What you must remember

- **Criteria:** fever of five days or more plus at least four of five — bilateral bulbar conjunctival injection without exudate, lip and mouth changes (strawberry tongue, cracked red lips), extremity changes (indurative oedema acutely, periungual desquamation later), polymorphous non-vesicular rash, and cervical nodes of at least 1.5 centimetres.
- **Supportive clues:** irritability, redness of a BCG scar, sterile pyuria, deranged liver enzymes and arthritis; thrombocytosis rises in the second week.
- **Incomplete disease:** fewer criteria with compatible laboratory changes and echocardiographic findings still warrants treatment, especially in young infants with persistent fever.
- **Coronary risk:** aneurysms complicate a meaningful proportion of untreated children; echocardiography is done at diagnosis and follow-up, with giant aneurysms (beyond about 8 millimetres) carrying thrombosis risk.
- **Treatment:** intravenous immunoglobulin 2 g/kg as a single infusion, ideally days five to seven; fever persisting 36 hours later defines resistance, treated with repeat infusion or infliximab.
- **Aspirin:** current international guidance prefers moderate anti-inflammatory doses (30-50 mg/kg/day) acutely — older textbooks list 80-100 mg/kg/day — stepping down to 3-5 mg/kg/day once afebrile, continued about six to eight weeks if coronary arteries are normal.
- **Live vaccines:** measles and varicella vaccination is deferred for about 11 months after immunoglobulin.

## Common confusion

Kawasaki disease is most often confused with measles and scarlet fever. Measles has exudative conjunctivitis, Koplik spots, cough and coryza; scarlet fever has exudative pharyngitis, Pastia's lines, a sandpaper rash and responds promptly to antibiotics — while Kawasaki fever smoulders unresponsive to both. Desquamation timing also confuses: peeling of fingers and toes belongs to the subacute phase, often absent in week one, so a child can fulfil criteria without it. And do not wait for a full house of criteria: young infants present incompletely yet carry the highest aneurysm risk.

## Exam-focused takeaway

NEET-PG builds Kawasaki questions around the criteria count, the two drugs and the timing rule — IVIG 2 g/kg plus aspirin within ten days. Vignettes describe an irritable toddler with five days of fever, red eyes without pus, cracked lips and a flared BCG scar; the next-best-step answer is echocardiography and IVIG, not antibiotics. Learn the discriminators against measles and scarlet fever, the aspirin dose shift in recent guidance, and the live-vaccine deferral. "Leading acquired heart disease in children" is the recurring one-liner.

## Frequently asked questions

### What are the diagnostic criteria?

Fever of five days or more plus at least four of five: non-exudative conjunctivitis, oral changes, extremity changes, polymorphous rash and cervical lymphadenopathy.

### Why treat within ten days?

Immunoglobulin given in the first ten days — ideally around days five to seven — markedly reduces coronary artery aneurysms; later treatment protects far less.

### What is the standard treatment?

A single infusion of intravenous immunoglobulin 2 g/kg with aspirin; fever persisting 36 hours afterwards defines resistance, treated with repeat infusion or infliximab.

### What dose of aspirin is used?

Current international guidance prefers moderate-dose aspirin (30-50 mg/kg/day) acutely, shifting to a low antiplatelet dose (3-5 mg/kg/day) once afebrile; older texts list higher doses.

### Can it be diagnosed with fewer criteria?

Yes — incomplete Kawasaki disease: fewer features with supportive laboratory markers and echocardiography, particularly in young infants, still warrants treatment.