History

Fact Explanation
Fever Usually lasts more than five days and occurs during the acute stage. [1] High spiking fever (39 - 40°C or higher) usually does not respond to antipyretics. Presence of fever and four out of the five criteria is diagnostic. [2,6,8]
Conjunctivitis Bilateral and non-suppurative. [2] This is a component of the diagnostic criteria.
Red cracked lips [2] Usually occurs with other oral symptoms. This is a component of the diagnostic criteria.
Changes in tongue or oral musosa. Reddish tongue known as “Strawberry tongue”. This is a component of the diagnostic criteria.[2]
Skin change in palms and soles Erythema and edema of the palms and soles during the first week, followed by peeling of the skin from fingertips during the convalescent stage (Day 14 to 21- sub acute period.). [2,8,10] This is a component of the diagnostic criteria.
Tender lymph nodes Common in the cervical group of lymph nodes. [1,8] This is owing to the thrombotic arteriolitis and severe lymphadenitis with necrosis. [12] This is a component of the diagnostic criteria.
Skin rash [2] Diffuse and polymorphic macular, maculopapular or urticarial rash. [8] This is a component of the diagnostic criteria.
Irritability and poor feeding [9,3] Young children will be irritable and this is one of the most common presenting complaints. It is believed to be due to aseptic meningitis. [3]
Vomiting [9] A nonspecific but relatively common presentation due to mesenteric arteritis[11] or it may even propose an infectious etiology to Kawasaki disease. [14]
Diarrhea [3,5,9] Due to mesenteric arteritis[11] or it may even propose an infectious etiology to Kawasaki disease. [14]
Rhinorrhea [9] The exact reason is unknown, but it is suspected that the underlying cause may be due to the diffuse vasculitis or could even be due to a possible infectious etiology to Kawasaki disease. [14]
Abdominal pain [9] Due to mesenteric arteritis[11] or it may even be due to a possible infectious etiology of Kawasaki disease. [14]
Joint pain [3,5,9] The exact reason is unknown. May be due to the diffuse vasculitis or could even be due to a possible infectious etiology of Kawasaki disease. [14]
Uveitis [3,5] The exact reason is unknown.
Dysuria [3,5] Sterile pyuria and sometimes proteinuria occurs. [9]
Erythema and induration at the site of previous Bacillus Calmette–Guérin (BCG) immunization. A nonspecific finding, due to the cross reactivity of T lymphocytes. [3,4]
Jaundice [3,5] This is a relatively uncommon presentation.
Febrile convulsions [3,5] An uncommon presentation.
Sudden death Undetected coronary artery aneurysms may lead to sudden death. [7]
Angina Due to the subsequent development of coronary artery stenosis. [13]
References
  1. ANTHONY H, MASATO TAKAHASHI, DAVID BURGNER. Kawasaki disease. BMJ [online] 2009; 338. [viewed 20 March 2014] Available from: http://www.bmj.com/content/338/bmj.b1514
  2. ELEFTHERIOU D, LEVIN M, SHINGADIA D, TULLOH R, KLEIN NJ, BROGAN PA. Management of Kawasaki disease. Arch Dis Child [online] 2014;99:74-83. [Viewed 20 March 2014] Available from: http://adc.bmj.com/content/99/1/74.full
  3. BROGAN PA, BOSE A, BURGNER D, et al. Kawasaki disease: an evidence based approach to diagnosis, treatment, and proposals for future research. Arch Dis Child [online] 2002;86:286–90. [viewed 20 March 2014]
  4. SINHA R, BALAKUMAR T. BCG reactivation: a useful diagnostic tool even for incomplete Kawasaki disease. Arch Dis Child [online] 2005;90:891. [viewed 20 March 2014]
  5. DILLON MJ, ELEFTHERIOU D, BROGAN PA. Medium-size-vessel vasculitis. Pediatr nephrol [online] 2010;25:1641–52. [viewed 20 March 2014] Available from: doi: 10.1007/s00467-009-1336-1.
  6. ALBERTO C. Can Kawasaki Disease Be Managed? Perm J. [online] 2012. Spring 16(2): 70-72. [viewed 20 March 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383169/
  7. FUJIWARA H, HAMAAHIMA Y. Pathology of the heart in Kawasaki disease. Pediatrics. [online] 1978 Jan;61(1):100–7. [viewed 20 March 2014]
  8. IAN KM. KAWASAKI DISEASE. Arch Dis Child Educ Pract Ed [online] 2004;89. [viewed 20 March 2014] Available from: http://ep.bmjjournals.com/content/89/1/ep3.extract?related-urls=yes&legid=edpract;89/1/ep3
  9. Diagnostic Guidelines for Kawasaki Disease. Circulation. [online] 2001; 103: 335-336. [viewed 20 March 2014] Available from: doi: 10.1161/​01.CIR.103.2.335
  10. Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the AHA's Council on Cardiovascular Disease in the Young. Diagnostic guidelines for Kawasaki disease. Dallas: American Heart Association. [online] 1989. [viewed 20 March 2014]
  11. KURASHIGE M, NAOE S, MASUDA H, TANAKA N. A morphological study of the digestive tract in Kawasaki disease: 31 autopsies [in Japanese]. Myakkangaku. [online] 1984; 24: 407–418. [viewed 20 March 2014]
  12. NAOE S,TAKAHASHI K, MASUDA H, TANAKA N. Kawasaki disease. With particular emphasis on arterial lesions. Acta Pathol Jpn. [online] 1991; 41: 785–797. [viewed 20 March 2014]
  13. HIDEAKI S,Heart Disease in Asia,Long-Term Outcome of Kawasaki Disease. Circulation. [online] 2008; 118: 2763-2772. [viewed 20 March 2014] Available from: http://circ.ahajournals.org/content/118/25/2763.full
  14. YUN SH, YANG NR, PARK SIN AE. Associated Symptoms of Kawasaki Disease. Korean Circulation Journal [online]. July 2011, vol.41(7): 394-398 [viewed 20 March 2014]. Available from: doi: 10.4070/kcj.2011.41.7.394

Examination

Fact Explanation
Tender lymphadenopathy [1] Usually of the cervical group of lymph nodes. [1] It is usually isolated and more than 1.5cm in size. [1] This is a component of the diagnostic criteria.
Skin rash Polymorphous rash with no vesicles or crusts. Petechial rash may be found rarely. [2,3]. This is a diagnostic criterion. [1]
Red cracked lips or diffuse erythema of oropharynx [1] Due to the systemic vasculitis. This is a diagnostic criterion. [5,6]
Strawberry tongue [1] This is a diagnostic criterion.
Changes in the skin of palms and soles Erythema and edema of palms and soles is followed by the peeling of skin on fingertips. [1]
Fever Due to systemic vasculitis. [5,6]
Features of Heart Failure (HF) Dyspnea, Orthopnea. Tachycardia, Gallop rhythm. [4]
Ataxia A relatively rare examination finding. [2,3]
References
  1. ELEFTHERIOU D, LEVIN M, SHINGADIA D, TULLOH R, KLEIN NJ, BROGAN PA. Management of Kawasaki disease. Arch Dis Child [online] 2014;99:74-83. [viewed 20 March 2014]. Available from: doi:10.1136/archdischild-2012-302841.
  2. BROGAN PA, BOSE A, BURGNER D, et al. Kawasaki disease: an evidence based approach to diagnosis, treatment, and proposals for future research. Arch Dis Child [online] 2002;86:286–90. [viewed 20 March 2014].
  3. DILLON MJ, ELEFTHERIOU D, BROGAN PA. Medium-size-vessel vasculitis. Pediatr nephrol [online] 2010;25:1641–52. [viewed 20 March 2014].
  4. NEWBURGER JW, TAKAHASHI M, GERBER MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease. Circulation [online] 2004;110:2747–71. [viewed 20 March 2014].
  5. Diagnostic Guidelines for Kawasaki Disease. Circulation. [online] 2001; 103: 335-336. [viewed 20 March 2014]. Available from: doi: 10.1161/​01.CIR.103.2.335
  6. JANELLE RC, ROBERT E SALLIS. Recognition of Kawasaki Disease. Perm J. [online] 2009: 13(1): 57-61. [viewed 20 March 2014]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3034467/

Differential Diagnoses

Fact Explanation
Febrile illnesses Early clinical features are similar to a febrile illness. [1]
Acute gastroenteritis Child can have vomiting, diarrhea and abdominal pain in both conditions. [3,4,5]
Rocky Mountain spotted fever Also presents with fever and an accompanying rash.
Juvenile rheumatoid arthritis [7] Characteristic salmon-pink macular rash appears with fever spikes and disappears completely when the fever settles (evanescent rash). Some times it is migratory and shows Koebner phenomena. Rash is occasionally pruritic. [12]
Exudative conjunctivitis As opposed to the non-suppurative conjunctivitis occurring in Kawasaki disease. [6]
Scarlet fever Scarlet fever presents with fever, rash, diffuse and flaking desquamation and mucous membrane changes. [7]
Toxic shock syndrome In Kawasaki disease, desquamation begins in the periungual region. Toxic shock syndrome is a more systemic disease. [13]
Drug reactions [8] Amoxicillin is known to cause fever with skin and mucosal changes. [7] Penicillins, cephalosporins, sulfonamides, anticonvulsants, and allopurinol may also produce an erythematous skin rash. [9,10]
Leptospirosis [7,8] Fever, nausea, vomiting, and diarrhea are common presentations of leptospirosis. Conjunctivitis, palpable lymph nodes and arthralgia and skin rashes are less common presentations. [11]
Urinary Tract Infection (UTI) Dysuria can mimic a UTI. Urine Full Report will reveal sterile pyuria and sometimes proteinuria. [2]
References
  1. ANTHONY H, MASATO TAKAHASHI, DAVID BURGNER. Kawasaki disease. BMJ [online] 2009 May 5; 338. [viewed 20 March 2014]. Available from: http://www.bmj.com/content/338/bmj.b1514
  2. Diagnostic Guidelines for Kawasaki Disease. Circulation. [online] 2001; 103: 335-336. [viewed 20 March 2014]. Available from: doi: 10.1161/​01.CIR.103.2.335.
  3. BROGAN PA, BOSE A, BURGNER D, et al. Kawasaki disease: an evidence based approach to diagnosis, treatment, and proposals for future research. Arch Dis Child [online] 2002;86:286–90. [viewed 20 March 2014].
  4. DILLON MJ, ELEFTHERIOU D, BROGAN PA. Medium-size-vessel vasculitis. Pediatr nephrol [online] 2010;25:1641–52. [viewed 20 March 2014]. Available from: doi: 10.1007/s00467-009-1336-1.
  5. Diagnostic Guidelines for Kawasaki Disease. Circulation. [online] 2001; 103: 335-336. [viewed 20 March 2014]. Available from: http://circ.ahajournals.org/content/103/2/335.full
  6. JANELLE RC, ROBERT E SALLIS. Recognition of Kawasaki Disease. Perm J. [online] 2009: 13(1): 57-61. [viewed 20 March 2014]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3034467/
  7. HUSSON RN, MARK EJ. Case records of the Massachusetts General Hospital. Weekly clinicopathology exercises. Case 23-1999. A 10-month-old girl with fever, upper lobe pneumonia, and a pleural effusion. N Engl J Med. [online] 1999 Jul 29;341(5):353–60. [viewed 20 March 2014]. Available from: DOI: 10.1056/NEJM199907293410508
  8. DAJANI AS, TAUBERT KA, GERBER MA, SHULMAN ST, FERRIERI P, FREED M, et al. Diagnosis and therapy of Kawasaki disease in children. Circulation [online] 1993;87:1776–80. [viewed 20 March 2014].
  9. VALEYRIE-ALLANORE L, SASSOIAS B, ROUJEAU JC. Drug-induced skin, nail, and hair disorders. Drug Saf. [online] 2007;30:1011-1030. [viewed 20 March 2014].
  10. LAW RM, LAW DTS. In: DIPIRO JT, TALBERT RL, YEE GC, et al, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York, NY: The McGraw Hill Companies, Inc; 2008:1661-1672.
  11. Centers for Disease Control and Prevention. Leptospirosis. [viewed 20 March 2014]. Available from: http://www.cdc.gov/leptospirosis/symptoms/index.html
  12. HAHN YOUN-SOO, KIM JOONG-GON. Pathogenesis and clinical manifestations of juvenile rheumatoid arthritis. Korean Journal of Pediatrics.[online] Nov 2010: 53(11): 921-930. [viewed 20 March 2014] Available from: doi: 10.3345/kjp.2010.53.11.921
  13. DAVIS JP. DWORKIN, MS. Outbreak Investigations Around the World: Case Studies in Infectious Disease Field Epidemiology. Boston: Jones and Bartlett Publisher; 2009. The Investigation of TSS in Wisconsin And Beyond, 1979-1980; p. 88.

Investigations - for Diagnosis

Fact Explanation
Full Blood Count (FBC) Usually leukocytosis is seen. [1] Thrombocytosis can occur during the sub-acute phase. [11]
C-reactive protein (CRP) CRP is an inflammatory marker and is increased in Kawasaki disease. [1,11]
Erythrocyte sedimentation rate (ESR) ESR is also elevated due to the systemic inflammation. [1,11] In persistent and unexplained elevation of CRP and ESR,Kawasaki disease should be a possible differential diagnosis. [2,3] In the absence of above two factors Kawasaki disease is less likely. [2,3,4]
2D Echocardiogram Echo cardiogram shows evidence of coronary vasculitis. [1] The coronary arterial wall is damaged by the proteolytic enzymes. Damaged arterial walls form aneurysms. [5,6] However normal echo cardiogram does not exclude the diagnosis of Kawasaki disease and at least 3 echo cardiograms should be done during the first six weeks of illness. [1,3,9]
Coronary arteriography This detects the degree of stenosis of the coronary arteries and enable planning timely intervention. [8]
Serum protein Hypoalbuminemia is a common finding. [2,3,4,]
Cerebro-spinal fluid (CSF) analysis Lymphocytes are predominant in CSF. [2,3,4,]
Liver transaminases The liver enzymes are increased due to hepatic congestion. [11]
References
  1. ELEFTHERIOU D, M LEVIN, D SHINGADIA, R TULLOH, NJ KLEIN, PA BROGAN. Management of Kawasaki disease. Arch Dis Child [online] 2014;99:74-83. [viewed 20 March 2014]. Available from: doi:10.1136/archdischild-2012-302841
  2. DILLON MJ, ELEFTGERIOU D, BRAGAN PA. Medium-size-vessel vasculitis. Pediatr Nephrol [online] 2010;25:1641–52. [viewed 20 March 2014]. Available from: doi: 10.1007/s00467-009-1336-1.
  3. NEWBURGER JW, TAKAHASHI M, GERBER MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease. Circulation [online] 2004;110:2747–71. [viewed 20 March 2014].
  4. BROGAN PA, BOSE A, BURGNER D, et al. Kawasaki disease: an evidence based approach to diagnosis, treatment, and proposals for future research. Arch Dis Child [online] 2002;86:286–90. [viewed 20 March 2014].
  5. EBERHARD BA, ANDERSSON U, LAXER, ROSE V, SILVERMAN ED. Evaluation of the cytokine response in Kawasaki disease. Pediatr Infect Dis J. [online] 1995; 14: 199–203. [viewed 20 March 2014].
  6. SENZAKI H, MASUTANI S, KOBAYASHI J, KOBAYASHI T, NAKANO H, NAGASAKA H, SASAKI N, ASANO H, KYO S, YOKOTE Y. Circulating matrix metalloproteinases and their inhibitors in patients with Kawasaki disease. Circulation. [online] 2001; 104: 860–863. [viewed 20 March 2014].
  7. HIDEAKI S, Heart Disease in Asia,Long-Term Outcome of Kawasaki Disease. Circulation. [online] 2008; 118: 2763-2772. [viewed 20 March 2014]. Available from: http://circ.ahajournals.org/content/118/25/2763.full
  8. ANTHONY H, MASAO TAKAHASHI, DAVID BURGNER. Kawasaki disease. BMJ [online] 2009; 338. [viewed 20 March 2014]. Available from: http://www.bmj.com/conent/338/bmj.b1514
  9. LEGA JC, BOZIO A, CIMAZ R, et al. Extracoronary echocardiographic findings as predictors of coronary artery lesions in the initial phase of Kawasaki disease. Arch Dis Child [online] 2013;98:97–102. [viewed 20 March 2014].
  10. Diagnostic Guidelines for Kawasaki Disease. Circulation [online] 2001; 103: 335-336. [viewed 20 March 2014]. Available from: http://circ.ahajournals.org/content/103/2/335.full
  11. JANELLE RC, ROBERT E SALLIS. Recognition of Kawasaki Disease. Perm J. [online] 2009: 13(1): 57-61. [viewed 20 March 2014]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3034467/

Investigations - Followup

Fact Explanation
Echocardiogram Complications like mitral regurgitation and pericardial effusion [5] will be detected, due to endocarditis and pericarditis respectively. [9] Echocardiogram is the most useful investigation in determining the prognosis. [7] This is dine in 6–8 weeks after the onset of the disease, and repeated weekly if aneurysms detected on initial echocardiography. [4,7,11]
Serum sodium Syndrome of inappropriate antidiuretic hormone (SIADH) secretion is a recognized complication. Serum sodium will be low in SIADH. [1]
Platelet count Acute thrombocytopenia or low/normal platelet count may be associated with a poorer prognosis. [3,4]
Liver function test Patients presenting with jaundice may have elevated liver enzymes and deranged liver functions [3,4] due to hepatic congestion. [11]
Coronary arteriography Detects the degree of coronary stenosis and the presence of coronary aneurysms enable timely interventions. [6,7]
Intravascular ultrasound (IVUS) Visualizes the morphology and histology of coronary vessels. [8]
Electrocardiogram (ECG) Detects cardiac arrhythmias. [10] ECG once in 6–12 months is recommended. [4,7]
Stress ECG All patients with persistent structural abnormalities of the coronary arteries should undergo a stress ECG. [7]
References
  1. MUISE A, TALLETT SE, SILVERMAN ED. Are children with Kawasaki disease and prolonged fever at risk for macrophage activation syndrome? Pediatrics [online] 2003;112:e495–7. [viewed 20 March 2014].
  2. MINE K, TAKAYA J, HASUI M, et al. A case of Kawasaki disease associated with syndrome of inappropriate secretion of antidiuretic hormone. Acta Paediatrica [online] 2004;93:1547–9. [viewed 20 March 2014].
  3. DILLON MJ, ELEFTHERIOU D, BROGAN PA. Medium-size-vessel vasculitis. Pediatr Nephrol [online] 2010;25:1641–52. [viewed 20 March 2014] Available from: doi: 10.1007/s00467-009-1336-1
  4. BROGAN PA, BOSE A, BURGNER D, et al. Kawasaki disease: an evidence based approach to diagnosis, treatment, and proposals for future research. Arch Dis Child [online] 2002;86:286–90. [viewed 20 March 2014].
  5. LEGA JC, BOZIO A, CIMAZ R, et al. Extracoronary echocardiographic findings as predictors of coronary artery lesions in the initial phase of Kawasaki disease. Arch Dis Child [online] 2013;98:97–102. [viewed 20 March 2014].
  6. ANTHONY H, MASATO TAKAHASHI, DAVVIDD BURGNER. Kawasaki disease. BMJ [online] 2009; 338. [viewed 20 March 2014]. Available from: http://www.bmj.com/conent/338/bmj.b1514
  7. NEWBURGER JW, TAKAHASHI M, GERBER MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease. Circulation [online] 2004;110:2747–71. [viewed 20 March 2014].
  8. HIDEAKI S,Heart Disease in Asia,Long-Term Outcome of Kawasaki Disease. Circulation. [online] 2008; 118: 2763-2772. [viewed 20 March 2014]. Available from: http://circ.ahajournals.org/content/118/25/2763.full
  9. AKAGI T, KATO H, INOUE O, SATO N, IMAMURA K. Valvular heart disease in Kawasaki syndrome: incidence and natural history. Am Heart J. [online] 1990; 120: 366–372. [viewed 20 March 2014].
  10. ALBERTO C. Can Kawasaki Disease Be Managed? Perm J. [online] 2012. Spring 16(2): 70-72. [viewed 20 March 2014]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383169/
  11. JANELLE RC, ROBERT E SALLIS. Recognition of Kawasaki Disease. Perm J. [online] 2009: 13(1): 57-61. [viewed 20 March 2014]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3034467/

Management - General Measures

Fact Explanation
Antipyretics Fever does not usually respond to antipyretics. [1]
Varicella zoster virus (VZV) vaccine Patients who require long term aspirin therapy should be vaccinated since this reduces the risk of developing Reye’s syndrome. [1]
References
  1. ANTHONY H, MASATO TAKAHASHI, DAVID BURGNER. Kawasaki disease. BMJ [online] 2009; 338. [viewed 20 March 2014]. Available from: http://www.bmj.com/content/338/bmj.b1514

Management - Specific Treatments

Fact Explanation
Intravenous immunoglobulin (IVIG) [1] If given within 5-10 days of onset of fever this reduces the incidence of coronary artery aneurysm formation. [1,2,3,4] IVIG is most effective when given as a single dose. [5]
Aspirin Aspirin should be given with IV IG. [1] The dose is 30–50 mg/kg/day. [1] If coronary artery aneurysms persists, anti-platelet therapy (low-dose aspirin, 2–5 mg/kg) should be continued till the aneurysms resolve. [3] IV IG and aspirin are the mainstay of the treatment. [20] All the other treatment options are less commonly practiced.
Corticosteroids For patients with IV IG-resistance corticosteroids are known to be effective. [1] This is not routinely used and it is less effective than the combination of IVIG and aspirin. [3,21]
Pentoxifylline Specifically inhibits TNF-α messenger RNA transcription and there by limits the inflammation. [19]
Plasma exchange [1,12,18] Remove the antibodies responsible for vasculitis. [12,15]
Infliximab This is an anti-tumour necrosis factor (TNF)-α antibody, a novel therapy for the treatment of Kawasaki disease. [6,7,8,9]
Etanercept A soluble TNF-α receptor, which antagonize the action of TNF- α. Dose is 0.8 mg per kilogram weekly for three doses. [10]
Ciclosporin, cyclophosphamide [1,12,18] Immune modulators. [12]
Cyclophosphamide [1,18] An immune suppressive agent
Abciximab [12] Modulates the vascular remodeling. [13]
Methotrexate [1,18] Especially if IVIG and steroids fail in treatment.
Urinastatin Neutrophil elastase inhibitior. [14]
Warfarin In the presence of large aneurysms (≥6 mm) anticoagulation is needed. [11]
Coronary intervention [19] Coronary artery bypass graft (CABG) or transluminal coronary balloon angioplasty [15], stent implantation [16] and percutaneous transluminal coronary rotational ablation [17] can be done to re-vascularize.
References
  1. ANTHONY H, MASATO TAKAHASHI, DAVID BURGNER. Kawasaki disease. BMJ [online] 2009; 338. [viewed 20 March 2014]. Available from: http://www.bmj.com/content/338/bmj.b1514
  2. D ELEFTHERIOU, M LEVIN, D SHINGADIA, R TULLOH, NJ KLEIN, PA BROGAN. Management of Kawasaki disease. Arch Dis Child [online] 2014;99:74-83. [viewed 20 March 2014] http://adc.bmj.com/content/99/1/74.full
  3. NEWBURGER JW, TAKAHASHI M, GERBER MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease. Circulation [online] 2004;110:2747–71. [viewed 20 March 2014].
  4. DURONGPISITKUL K, GURURAJ VJ, PARK JM, et al. The prevention of coronary artery aneurysm in Kawasaki disease: a meta-analysis on the efficacy of aspirin and immunoglobulin treatment. Pediatrics [online] 1995;96:1057–61. [viewed 20 March 2014].
  5. NEWBURGER JW, TAKAHASHI M, BEISER AS, et al. A single intravenous infusion of gamma globulin as compared with four infusions in the treatment of acute Kawasaki syndrome. N Engl J Med [online] 1991;324:1633–9. [viewed 20 March 2014].
  6. LAU AC, DUONG TT, ITO S, et al. Matrix metalloproteinase 9 activity leads to elastin breakdown in an animal model of Kawasaki disease. Arthritis Rheum [online] 2008;58:854–63. [viewed 20 March 2014].
  7. WEISS JE, EBERHARD BA, CHOWDHURY D, et al. Infliximab as a novel therapy for refractory Kawasaki disease. J Rheumatol [online] 2004;31:808–10. [viewed 20 March 2014].
  8. OISHI T, FUJIEDA M, SHIRAISHI T, et al. Infliximab treatment for refractory Kawasaki disease with coronary artery aneurysm. Circ J [online] 2008;72:850. [viewed 20 March 2014].
  9. BROGAN RJ, ELEFTHERIOU D, GNANAPRAGASAM J, et al. Infliximab for the treatment of intravenous immunoglobulin resistant Kawasaki disease complicated by coronary artery aneurysms: a case report. Pediatr Rheumatol Online J [online] 2009;7:3. [viewed 20 March 2014].
  10. CHOUEITER NF, OLSON AK, SHEN DD, et al. Prospective open-label trial of etanercept as adjunctive therapy for Kawasaki disease. J Pediatr [online] 2010;157:960–6. [viewed 20 March 2014].
  11. SUGAHARA Y, ISHIL M, MUTA H, et al. Warfarin therapy for giant aneurysm prevents myocardial infarction in Kawasaki disease. Ped Cardiol [online] 2008;29:398–401. [viewed 20 March 2014].
  12. HIDEAKI S, Heart Disease in Asia,Long-Term Outcome of Kawasaki Disease. Circulation. [online] 2008; 118: 2763-2772. [viewed 20 March 2014]. Available from: http://circ.ahajournals.org/content/118/25/2763.full
  13. WILLIAMS RV, WILKE VM, TANNI LY, MINICH LL. Does abciximab enhance regression of coronary aneurysms resulting from Kawasaki disease? Pediatrics. [online] 2002; 109: E4. [viewed 20 March 2014].
  14. NAKANO M, KAMIJO Y, TOYAODA M. Preventive effects of urinastatin for coronary artery aneurysm formation in Kawasaki disease. In: Kato H, ed. Kawasaki Disease: Proceedings of the 5th International Kawasaki Disease Symposium, Fukuoka, Japan, 22–25 May 1995. New York, NY: Elsevier; 1995: 364–371. [viewed 20 March 2014].
  15. NISHIMURA H, SAWADA T, AZUMA A, KOHNO Y, KATSUME H, NAKAGAWA M, SAKATA K, HAMAOKA K, ONOUCHI Z. Percutaneous transluminal coronary angioplasty in a patient with Kawasaki disease: a case report of an unsuccessful angioplasty. Jpn Heart J. [online] 1992; 33: 869–873. [viewed 20 March 2014].
  16. HIJAZI ZM, SMITH JJ, FULTON DR. Stent implantation for coronary artery stenosis after Kawasaki disease. J Invasive Cardiol. [online] 1997; 9: 534–536. [viewed 20 March 2014].
  17. TSUDA E, MIYAZAKI S, YAMADA O, TAKAMURO M, TAKEKAWA T, ECHIGO S. Percutaneous transluminal coronary rotational atherectomy for localized stenosis caused by Kawasaki disease. Pediatr Cardiol. [online] 2006; 27: 447–453. [viewed 20 March 2014].
  18. DILLON MJ, ELEFTHERIOU D, BROGAN PA. Medium-size-vessel vasculitis. Pediatr Nephrol [online] 2010;25:1641–52. [viewed 20 March 2014]. Available from: doi: 10.1007/s00467-009-1336-1
  19. JANE W. NEWBURGER, MASATO TAKAHASHI, MICHAEL A. GERBER, MICHAEL H. GEWITZ, LLOYD Y. TANI, JANE C. BURNS, STANFORD T. SHULMAN, ANN F. BOLGER, PATRICIA FERRIERI, ROBERT S. BALTMORE, WAALTER R. WILSON, LARRY M. BADDOUR, MATTHEW E. LEVISON, THOMAS J. PALLASCH, DONALD A. FALACE, KATHRYN A. TAUBERT. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease. Circulation. [online] 2004; 110: 2747-2771. [viewed 20 March 2014].
  20. DAJANI AS, TAUBERT KA, GERBER MA, SHULMAN ST, FERRIERI P, FREED M, et al. Diagnosis and therapy of Kawasaki disease in children. Circulation. [online] 1993;87:1776–80. [viewed 20 March 2014].
  21. FURUSHO K, KAMIYA T, NAKANO H, KIYOSAWA K, SHINOMIYA K, HAYASHIDERA T, et al. High-dose intravenous gammaglobulin for Kawasaki disease. Lancet. [online] 1984;2(8411):1055–8. [viewed 20 March 2014].