Kawasaki Disease Differential Diagnoses

Updated: Jun 07, 2022
  • Author: Tina K Sosa, MD; Chief Editor: Russell W Steele, MD  more...
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Diagnostic Considerations

Various infections can mimic KD. These include but are not limited to the following:

  • Preseptal cellulitis

  • Retropharyngeal abscess, phlegmon, or cellulitis

  • Peritonsillar abscess

  • Cervical lymphadenitis or deep neck infection

  • Group A beta-hemolytic streptococcal infection

  • Adenovirus

  • Enterovirus

  • Mononucleosis

  • Parvovirus B19 infection

  • Scarlet fever

  • Staphylococcal or streptococcal toxic shock syndrome

  • Meningitis

  • Rocky Mountain spotted fever

A study that reported on the role of respiratory viruses in the pathogenesis of KD found that more than 40% of children with KD also tested positive for respiratory viruses when they were admitted to the hospital. As a result, the authors note that a positive respiratory viral PCR or presence of respiratory symptoms at the time of presentation should not be used to exclude a diagnosis of KD. [58, 59]  Aside from infections, KD also has overlap with numerous drug hypersensitivity reactions and rheumatologic disorders, including juvenile idiopathic arthritis and systemic lupus erythematosus, which should be considered..

If KD is suspected but the diagnosis cannot be confirmed, the patient should be referred in a timely manner to a center that has experience with this illness. It is important to diagnose KD promptly, because a delay can result in CAAs or other serious cardiac complications. Patients who are not treated with IVIG by day 10 illness are at an increased risk of cardiac sequelae and sudden death.

Differential Diagnoses