Intended for healthcare professionals

Practice Easily Missed?

Kawasaki disease

BMJ 2014; 349 doi: (Published 17 September 2014) Cite this as: BMJ 2014;349:g5336
  1. Anthony Harnden, professor of primary care1,
  2. Robert Tulloh, professor of congenital cardiology2,
  3. David Burgner, professor3
  1. 1Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  2. 2University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
  3. 3Murdoch Childrens Research Institute and Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
  1. Correspondence to: anthony.harnden{at}
  • Accepted 25 July 2014

This is one of a series of occasional articles highlighting conditions that may be more common than many doctors realise or may be missed at first presentation. The series advisers are Anthony Harnden, professor of primary care, Department of Primary Care Health Sciences, University of Oxford, and Richard Lehman, general practitioner, Banbury. To suggest a topic for this series, please email us at

Case scenario

A 2 year old boy was brought to see the general practitioner by his parents because of a four day history of fever. His parents noticed a rash and slightly “bloodshot” eyes the day before. The GP diagnosed a viral illness, offered reassurance, but gave good safety netting advice. The boy re-presented to his GP three days later, still intermittently febrile, irritable, and with an angry looking widespread morbilliform rash and a sore mouth. Kawasaki disease was suspected, and he was admitted to hospital where he received prompt treatment with intravenous immunoglobulin and high dose aspirin. An echocardiogram, performed during admission was normal, as were those during follow-up.

What is Kawasaki disease?

Kawasaki disease is an acute inflammatory vasculitis of medium size arteries that occurs mainly in children aged 6 months to 5 years but can occur at any age, including younger infants, and even occasionally in adults.1 2 3 Although one or multiple infectious triggers are most likely, the precise cause is unclear. Kawasaki disease is the commonest cause of acquired heart disease in children in industrialised countries because the coronary arteries are affected in about a quarter of untreated cases. The incidence of acquired heart disease in children is rising.4

How common is Kawasaki disease?

  • England—8.39 per 100 000 children under 5 years5

  • Australia—9.34 per 100 000 children under 5 years6

  • Japan—239 per 100 000 children under 5 years7

  • Korea—134 per 100 000 children under 5 years …

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