Fever and irritability are often the first indications of the disease. Fever ranges from moderate (101° to 103° F) to high (104° F and above). The lymph glands in the neck may become swollen. A rash usually appears on the back, chest and abdomen early in the illness; in infants it may develop in the groin. In some cases, the rash may spread to the face. The rash appears as poorly defined spots of various sizes, often bright red. Fever continues to rise and fall, sometimes for as long as three weeks. Bloodshot eyes may develop, and the eyes can become sensitive to light.
The child's tongue will commonly be coated, slightly swollen, and resemble the surface of a strawberry, sometimes referred to as "strawberry tongue." The lips usually become red, dry and cracked; the inside of the mouth may turn darker red than usual.
The palms of the hands and soles of the feet often become red, and hands and feet may swell. Occasionally, a stiff neck will develop. Some children have abdominal pain and diarrhea.
When the fever subsides, the rash and swollen lymph glands usually disappear. The skin around the toenails and fingernails often peels painlessly, usually during the second or third week of illness. The skin on the hands or feet may peel in large pieces.
The knees, hips and ankles may become swollen and painful. Occasionally joint pain and swelling persist after other symptoms have disappeared, but permanent joint damage doesn't occur. Lines or ridges on fingernails and toenails, formed during the illness, may be seen for weeks or months.
Photo courtesy of Kawasaki Disease Foundation
The diagnosis of Kawasaki disease cannot be made by a single laboratory test or combination of tests. Physicians make the diagnosis after carefully examining a child, observing signs and symptoms (including 5 or more days of fever) and eliminating the possibility of other, similar diseases. Blood tests are used to detect mild anemia, an elevated white blood cell count and an elevated sedimentation rate, indicating inflammation. A sharp increase in the number of platelets, a major clotting element in blood, also may be found. Urine tests may reveal the presence of protein (albumin) and white blood cells. An echocardiogram (or echo) is used to look for possible damage to the heart or to the coronary arteries that supply blood to the heart muscle. Other blood tests or diagnostic studies may be requested by the physician.
- Download our patient fact sheet: What is Kawasaki Disease? (PDF)