eMedicine Specialties > Rheumatology > Miscellaneous Inflammatory Arthritis

Kawasaki Disease: Follow-up

Author: Paul R Ogershok, MD, Allergist, Allergy, Asthma, and Immunology Clinic, Southwest Regional Medical Center
Coauthor(s): Martin Weisse, MD, Program Director, Associate Professor, Department of Pediatrics, West Virginia University
Contributor Information and Disclosures

Updated: Aug 6, 2009

Follow-up

Further Inpatient Care

  • Admit an affected patient to the hospital and administer intravenous gamma globulin. Consider aspirin and/or corticosteroids and observe until fever is controlled.
  • Carefully monitor cardiovascular performance.
  • Once the fever resolves, significant congestive heart failure or myocardial dysfunction is unlikely.

Further Outpatient Care

  • Re-evaluate all patients within 1 week of hospital discharge.
  • Schedule the patient for a repeat echocardiography 21-28 days after the onset of fever.
  • Further echocardiograms are usually unnecessary if baseline and 3- to 4-week echocardiograms fail to reveal any evidence of coronary aneurysms.
  • Patients with no cardiac changes on echocardiogram at any stage do not require activity restrictions or medications beyond 3 months after the initial illness.
  • Ensure that a patient with coronary artery aneurysms or other cardiac abnormalities receives further care, as dictated by a cardiologist.

Transfer

  • Transfer any patient with suspected Kawasaki disease to a facility that has skilled clinicians and a pediatric or adult cardiologist to evaluate the echocardiogram.

Complications

  • Cardiovascular
    • Once fever has resolved, significant heart failure or myocardial dysfunction is unlikely.
    • Diffuse coronary artery ectasia and aneurysm formation, giant aneurysm (internal luminal diameter >8 mm)
    • Myocardial infarction may occur.
    • Myocarditis is common but rarely causes congestive heart failure.
    • Valvulitis, usually mitral, occurs in only 1% of patients and rarely merits valve replacement.
    • Pericarditis with small pericardial effusions occurs in 25% of patients who are acutely ill.
    • Systemic artery aneurysms may occur.
    • Rupture of coronary artery aneurysm with hemopericardium is possible.
  • Other complications
    • Extreme irritability, especially in younger infants
    • Aseptic meningitis
    • Arthritis
    • Mild hepatic dysfunction, rarely jaundice
    • Gallbladder hydrops (may be demonstrated on sonogram, but the condition usually resolves without surgical intervention)
    • Diarrhea
    • Pneumonitis
    • Otitis media
    • Erythema and induration at the site of BCG inoculation
    • Peripheral extremity gangrene (extremely rare)

Patient Education

  • The recurrence rate in Japan is 3% and approximately 1% in North America.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose Kawasaki disease before 10 days of illness so that intravenous gamma globulin can be given to help prevent coronary artery aneurysms is a medicolegal pitfall.
  • If the diagnosis cannot be confirmed but is suspected, quickly refer the patient to a center with experience in Kawasaki disease.
 


More on Kawasaki Disease

Overview: Kawasaki Disease
Differential Diagnoses & Workup: Kawasaki Disease
Treatment & Medication: Kawasaki Disease
Follow-up: Kawasaki Disease
Multimedia: Kawasaki Disease
References
Further Reading
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References

  1. Kawasaki T. [Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children]. Arerugi. Mar 1967;16(3):178-222. [Medline].

  2. Uehara R, Yashiro M, Nakamura Y, Yanagawa H. Clinical features of patients with Kawasaki disease whose parents had the same disease. Arch Pediatr Adolesc Med. Dec 2004;158(12):1166-9. [Medline].

  3. Onouchi Y, Tamari M, Takahashi A, Tsunoda T, Yashiro M, Nakamura Y, et al. A genomewide linkage analysis of Kawasaki disease: evidence for linkage to chromosome 12. J Hum Genet. 2007;52(2):179-90. [Medline].

  4. Goo HW, Park IS, Ko JK, Kim YH. Coronary CT angiography and MR angiography of Kawasaki disease. Pediatr Radiol. Jul 2006;36(7):697-705. [Medline].

  5. Mavrogeni S, Papadopoulos G, Douskou M, Kaklis S, Seimenis I, Baras P, et al. Magnetic resonance angiography is equivalent to X-ray coronary angiography for the evaluation of coronary arteries in Kawasaki disease. J Am Coll Cardiol. Feb 18 2004;43(4):649-52. [Medline].

  6. [Best Evidence] Baumer JH, Love SJ, Gupta A, Haines LC, Maconochie I, Dua JS. Salicylate for the treatment of Kawasaki disease in children. Cochrane Database Syst Rev. 2006;(4):CD004175. [Medline].

  7. Hsieh KS, Weng KP, Lin CC, Huang TC, Lee CL, Huang SM. Treatment of acute Kawasaki disease: aspirin's role in the febrile stage revisited. Pediatrics. Dec 2004;114(6):e689-93. [Medline].

  8. [Best Evidence] Inour Y, Okada Y, Shinohara M, Kobayashi T, Kobayashi T, Tomomasa T, et al. A multicenter prospective randomized trial of corticosteroids in primary therapy for Kawasaki disease: clinical course and coronary artery outcome. J Pediatr. Sep/2006;149(3):336-341. [Medline].

  9. [Best Evidence] Newburger JW, Sleeper LA, McCrindle BW, Minich LL, Gersony W, Vetter VL, et al. Randomized trial of pulsed corticosteroid therapy for primary treatment of Kawasaki disease. N Engl J Med. Feb/2007;356(7):663-75. [Medline].

  10. Anderson MS, Todd JK, Glode MP. Delayed diagnosis of Kawasaki syndrome: an analysis of the problem. Pediatrics. Apr 2005;115(4):e428-33. [Medline].

  11. Baker AL, Lu M, Minich LL, Atz AM, Klein GL, Korsin R, et al. Associated symptoms in the ten days before diagnosis of Kawasaki disease. J Pediatr. Apr 2009;154(4):592-595.e2. [Medline].

  12. Barron KS, Shulman ST, Rowley A, Taubert K, Myones BL, Meissner HC, et al. Report of the National Institutes of Health Workshop on Kawasaki Disease. J Rheumatol. Jan 1999;26(1):170-90. [Medline].

  13. Burns JC, Best BM, Mejias A, Mahony L, Fixler DE, Jafri HS, et al. Infliximab treatment of intravenous immunoglobulin-resistant Kawasaki disease. J Pediatr. Dec 2008;153(6):833-8. [Medline].

  14. Burns JC, Shike H, Gordon JB, Malhotra A, Schoenwetter M, Kawasaki T. Sequelae of Kawasaki disease in adolescents and young adults. J Am Coll Cardiol. Jul 1996;28(1):253-7. [Medline].

  15. Feigin RD, Cecchin F. Disorders of Unknown Etiology: Kawasaki Disease. In: Oski's Pediatrics Principles and Practice. 3rd ed. 1999:924-32.

  16. Friter BS, Lucky AW. The perineal eruption of Kawasaki syndrome. Arch Dermatol. Dec 1988;124(12):1805-10. [Medline].

  17. Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST, et al. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. Mar 24 2009;119(11):1541-51. [Medline].

  18. Harnden A, Takahashi M, Burgner D. Kawasaki disease. BMJ. May 5 2009;338:b1514. [Medline].

  19. Kawasaki T, Kosaki F, Okawa S, Shigematsu I, Yanagawa H. A new infantile acute febrile mucocutaneous lymph node syndrome (MLNS) prevailing in Japan. Pediatrics. Sep 1974;54(3):271-6. [Medline].

  20. Kogulan P, Mbualungu E, Villanueva E. Kawasaki syndrome in an adult: case report and review of the literature in adolescents and adults. J Clin Rheumatol. 2001;7:194-8.

  21. Mason WH, Takahashi M. Kawasaki syndrome. Clin Infect Dis. Feb 1999;28(2):169-85; quiz 186-7. [Medline].

  22. Morens DM, Melish ME. Unclassified Infectious Diseases: Kawasaki Disease. In: Textbook of Pediatric Infectious Diseases. 4th ed. 1998:995-1014.

  23. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics. Dec 2004;114(6):1708-33. [Medline].

  24. Pahl E. Kawasaki disease: cardiac sequelae and management. Pediatr Ann. Feb 1997;26(2):112-5. [Medline].

  25. Rowley AH, Shulman ST. Kawasaki syndrome. Pediatr Clin North Am. Apr 1999;46(2):313-29. [Medline].

  26. Senzaki H. Long-term outcome of Kawasaki disease. Circulation. Dec 16 2008;118(25):2763-72. [Medline].

  27. [Guideline] Stapp J, Marshall GS. Fulfillment of diagnostic criteria in Kawasaki disease. South Med J. Jan 2000;93(1):44-7. [Medline].

  28. Taubert KA, Shulman ST. Kawasaki disease. Am Fam Physician. Jun 1999;59(11):3093-102, 3107-8. [Medline].

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Keywords

KD, Kawasaki syndrome, Kawasaki's syndrome, Kawasaki disease, Kawasaki's disease, mucocutaneous lymph node syndrome, infantile periarteritis nodosa, vasculitis, atypical KD, incomplete KD, atypical Kawasaki disease, incomplete Kawasaki disease, polymorphous rash, bilateral conjunctival injection, erythematous rash

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Contributor Information and Disclosures

Author

Paul R Ogershok, MD, Allergist, Allergy, Asthma, and Immunology Clinic, Southwest Regional Medical Center
Paul R Ogershok, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American College of Allergy, Asthma and Immunology, Pennsylvania Medical Society, and West Virginia State Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Martin Weisse, MD, Program Director, Associate Professor, Department of Pediatrics, West Virginia University
Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Medical Editor

Kristine M Lohr, MD, MS, Program Director, Professor, Department of Internal Medicine, Division of Rheumatology and Women's Health, University of Kentucky School of Medicine
Kristine M Lohr, MD, MS is a member of the following medical societies: American College of Physicians, American College of Rheumatology, and American Medical Women's Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Lawrence H Brent, MD, Associate Professor of Medicine, Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center
Lawrence H Brent, MD is a member of the following medical societies: American Association of Immunologists, American College of Physicians, and American College of Rheumatology
Disclosure: Genentech Honoraria Speaking and teaching; Genentech Grant/research funds Other; Amgen Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Abbott Immunology Honoraria Speaking and teaching

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD, Professor of Medicine, Temple University School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital
Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa
Disclosure: medifocus Honoraria Review panel membership; health dialogs Honoraria Consulting; West Penn Allegheny Health System None Board membership

 
 
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