Understanding Kawasaki Disease: Protecting Children’s Hearts By: Scarlett D Chatwin

        Introduction

Kawasaki Disease is an important yet often overlooked condition in paediatrics. Its symptoms

can closely resemble common childhood illnesses, making early recognition challenging and

increasing the risk of delayed treatment. I have personal experience with this disease, having

been misdiagnosed twice before this disease was identified. Both professionals and parents

should understand what Kawasaki Disease looks like and the patterns that it can present with,

so that the quickest treatment possible can be provided. The purpose of this article is to

provide a clear, accessible overview of the illness and to show why improving awareness is

key to preventing serious long-term complications.

Discussion

Despite decades of research, Kawasaki Disease currently has no known cause. Some current

evidence 1 suggests that it has genetic susceptibility or an environmental stimulus, as the

disease occurs more frequently in children of East Asian or Pacific Islander descent. 2 The

condition also has some characteristics of an infectious disease, including seasonal

fluctuations, though it is not contagious, and no bacterium, virus, or other pathogen has been

linked to Kawasaki Disease. The leading theory is that an external trigger causes an abnormal

immune response, resulting in inflammation of the blood vessels throughout the body, though

we are still unsure what this ‘trigger’ actually is.

Symptoms of Kawasaki Disease can very often be mistaken for other illnesses common

within this age group, making quick recognition challenging. A patient may not exhibit all of

these, but the most common symptoms to look out for would include: 3

- A high fever (>38°C or >100.4°F) that lasts for five or more days

- Swollen lymph nodes in the neck

- Red, cracked lips and a bright red tongue (often described as ‘strawberry tongue’)

1 Barnes, Benjamin Thea. “Kawasaki Disease.” Www.hopkinsmedicine.org, 2023,

www.hopkinsmedicine.org/health/conditions-and-diseases/kawasaki-disease

2 Mayo Clinic. “Kawasaki Disease - Symptoms and Causes.” Mayo Clinic, 8 Nov. 2023,

www.mayoclinic.org/diseases-conditions/kawasaki-disease/symptoms-causes/syc-20354598

3 National Health Service. “Kawasaki Disease.” Nhs.uk, 14 Mar. 2018, www.nhs.uk/conditions/kawasaki-

disease/

- Red eyes (known medically as conjunctival infection) without discharge

- A widespread rash

- Redness and swelling of the palms of the hands or soles of the feet

Unfortunately, there is no single, specific test for Kawasaki Disease. Instead, the diagnosis is

based on the patient’s clinical presentation, physical examination and medical history. Blood

and urine tests may be conducted to support the diagnosis and rule out any other possible

causes. An electrocardiogram (ECG) and an echocardiogram (an ultrasound scan of the heart)

can be used to assess any possible damage to the heart or coronary arteries.

Thankfully, there is an effective treatment option for Kawasaki Disease. One of the key

medications used is aspirin, which reduces fever and inflammation and reduces the risk of

blood clots forming. Typically, aspirin is avoided in patients under the age of 16 to avoid the

risk of Reye syndrome - a rare but potentially life-threatening medical emergency that causes

swelling in the brain and liver - but interestingly, Kawasaki Disease is one of the few

exceptions where its benefits outweigh the risks when under medical supervision. 4 The most

essential treatment is intravenous immunoglobulin (IVIg), which is a solution of antibodies

prepared from the plasma (the clear portion) of donated blood, administered through an IV

drip. Although the exact mechanism is not fully understood, it is thought to help by reducing

the abnormal overreaction of the immune system.

Kawasaki Disease should never be managed at home, and patients presenting symptoms

should always be seen by a medical professional as soon as possible. Although the disease

can actually self-resolve in about six to eight weeks if not professionally treated, this is

extremely dangerous. Around one in five untreated cases will lead to the patient developing

coronary artery damage, most commonly in the form of a coronary artery aneurysm - a

condition where the coronary artery walls will weaken and balloon outwards, leading to

blood clots, narrowing of vessels and in the worst cases, a heart attack. Without treatment, the

risk of death is approximately 2%, often due to severe cardiac complications. However, with

prompt treatment, most children make a full recovery. 5

Whilst current research continues to investigate what the possible cause of Kawasaki Disease

could be, many recent studies have looked into possible later cardiovascular complications.

One area of interest is the possible calcification of the coronary arteries following previous

damage. Calcification occurs when calcium is deposited within the walls of the arteries,

causing them to have reduced elastic recoil, which they naturally have so that they can

withstand the fluctuations in blood pressure caused by the pumping of the heart. This means

that there may be a reduced blood flow to the heart muscle, placing the patient at a higher risk

of future cardiovascular complications. 6 By understanding these long-term complications,

4 “Management - RCEMLearning.” RCEMLearning, 16 May 2022,

www.rcemlearning.co.uk/modules/kawasaki-disease/lessons/management-88/ . Accessed 30 June 2026.

5 “Kawasaki Disease (Mucocutaneous Lymph Node Syndrome) | DermNet NZ.” Dermnetnz.org,

dermnetnz.org/topics/kawasaki-disease

6 Etika, Matthew. Calcification after Cardiac Damage in Kwasaki Disease. 2025.

researchers are hoping to gain further insights into follow-up care and outcomes for those

diagnosed with Kawasaki Disease.

Why awareness matters

Raising awareness of Kawasaki Disease is very important as it can easily be mistaken for

more common childhood illnesses. Since there is no single test that would confirm a

diagnosis, meaning that the pattern of symptoms must be recognised by professionals, along

with quickly excluding any other possible conditions. Because fast treatment greatly reduces

the risk of long-term serious heart complications, recognising the disease early can have a

significant impact on patient outcomes.

I have experienced this diagnostic challenge firsthand. When my symptoms were brought to

the attention of my GP, I was initially misdiagnosed with scarlet fever and then, after a

second visit, with hand, foot and mouth, simply because the signs were so similar. It was only

after my mother found information from Societi, a charity and foundation dedicated to

supporting those affected by Kawasaki Disease, that the possibility of having this condition

was raised. Because this condition is relatively uncommon, it was not initially suspected. She

shared this information with my doctor, and I was immediately referred to my local hospital,

where the diagnosis was confirmed and treatment with IVIg began without delay. Since then,

I have had annual follow-up appointments with Birmingham Children’s Hospital to ensure

that there has been no long-term issues. My experience highlights the importance of

awareness, not only amongst healthcare professionals, but also in parents and carers, who

play a vital role in recognising when something just doesn’t feel right.

Conclusion

Kawasaki Disease may remain a rare illness, but its impact is significant. Although its cause

is unknown, early recognition and treatment are very important in preventing serious

complications. By understanding its symptoms and their pattern, healthcare professionals and

carers can play a crucial role in ensuring children receive timely and effective care.

Increasing awareness is therefore essential in reducing misdiagnosis and safeguarding long-

term health.