Pediatrics · Topic 12 of 42

Kawasaki Disease

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Pediatrics · cardiovascular

Kawasaki Disease

A vasculitis of young children that targets the coronary arteries. The danger is coronary artery aneurysms.

01 · Prevents aneurysmsIVIG + aspirin within 10 days of fever

02 · Suspect itFever 5 days or more + classic findings

03 · After IVIGDelay MMR and varicella 11 months

Why it happens

A vasculitis (inflamed blood vessels) that targets the coronary arteries

Coronary artery aneurysms — the danger

Leading cause of acquired heart disease in children

Most cases: children under 5 years old

Untreated, about 15–25% of children develop coronary aneurysms; IVIG within 10 days lowers that to about 3–5%. Most common in children of Asian descent, particularly Japanese.

What you'll see

High fever 5 days or more plus the classic mucocutaneous findings

High fever lasting 5 days or more must have

Bilateral conjunctivitis without drainage

Red cracked lips and strawberry tongue

Red swollen hands and feet

Trunk rash

One large neck lymph node

Extreme irritability

Peeling (desquamation) of fingers and toes after the fever subacute phase

Incomplete Kawasaki disease: fever 5 days or more with only 2–3 classic findings. Infants under 6 months with fever over 7 days get an echocardiogram.

Labs & diagnostics

The echocardiogram watches the coronaries

Baseline echocardiogram at diagnosis

Follow-up echoes over the next weeks

Platelets climb (thrombocytosis) in the subacute phase, when the risk of coronary clotting is highest.

Red flags

Fever persists or returns 36–48 hours after IVIG IVIG failed — report

Chest pain report now

New dysrhythmia report now

Signs of heart failure report now

Flu or chickenpox exposure while on aspirin Reye risk — call provider

Chest pain, dysrhythmia or heart failure suggest coronary or myocardial involvement. A non-responder usually gets a second IVIG dose.

Treatment

IVIGprevents coronary aneurysms

IV immunoglobulin

Best within 10 days of fever onset (ideally 7–10)

Fever persists 36–48 h after → report

Aspiringiven on purpose here

aspirin

High dose for inflammation, then low dose against clots

Flu or chickenpox → call the provider (Reye)

Comfortfor extreme irritability

Quiet room, clustered care, parent at the bedside

Aspirin doses and the IVIG infusion

Aspirin 80–100 mg/kg/day until afebrile for 48 hours

Then aspirin 3–5 mg/kg/day until about 6–8 weeks if coronaries are normal

IVIG is a large volume load on an inflamed heartmonitor vital signs during the infusion; report new respiratory distress or heart failure signs

Nursing priorities

Give IVIG + aspirin — IVIG within 10 days of fever onset

Report fever that persists or returns 36–48 hours after IVIG

Report chest pain, new dysrhythmia or heart failure signs

Quiet room, clustered care, parent at the bedside

Teach the vaccine delay and every cardiology follow-up

Which vaccines wait?

Donated antibodies in IVIG block measles and varicella vaccines

	Wait	Give
After high-dose IVIG	Delay MMR and varicella for 11 months	Inactivated vaccines stay on schedule
On long-term aspirin	No varicella vaccine while taking aspirin	Inactivated flu vaccine

Teach the family

Peeling fingers and toes after the fever is expected

Delay MMR and varicella vaccines 11 months after IVIG

On aspirin: flu or chickenpox → call the provider

Don't stop or continue aspirin on your own after exposure

Get the inactivated flu vaccine while on long-term aspirin

Keep every cardiology and echo appointment

Pearl

Kawasaki = fever 5 days or more + red eyes, red lips, red swollen hands and feet, rash and one big neck node. IVIG + aspirin within 10 days protects the coronaries.

Sources · Kawasaki Disease (StatPearls) · Timing and Spacing of Immunobiologics (CDC) · Follow your facility's protocol for IVIG administration.

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