The original criteria for the diagnosis of Kawasaki disease were drawn up by a committee appointed by the Japanese Ministry of Health. These were created primarily for the purposes of epidemiological surveillance, and to help exclude patients with rheumatic fever and Stevens-Johnson syndrome.¹ Cardiac ultrasound has subsequently provided a readily available, non-invasive method for detecting coronary artery abnormalities. Together with the lack of any “gold standard” specific diagnostic test for Kawasaki disease, this has led to the recognition that children presenting with incomplete clinical manifestations are also at risk of developing coronary artery abnormalities. This has been demonstrated in a number of publications, including a retrospective review in both children meeting the diagnostic criteria of Kawasaki disease, and those with incomplete criteria but treated with intravenous immunoglobulin (IVIG).² In this study cervical lymph node changes were the least commonly seen diagnostic feature, followed by the extremity changes.

Those seeking guidance on the diagnosis and management of Kawasaki disease can do no better than to refer to two recent reviews.^3,4 Both cover diagnosis and management. Maconochie⁴ particularly focuses on the differential diagnosis, diagnostic criteria, recommended investigations, and clinical assessment that are needed when Kawasaki disease is suspected. The Kawasaki Disease Research Group guidance in …