Evaluation of suspected incomplete Kawasaki Disease

1. AHA consensus recommendations
2. Infants ≤6 months old on day ≥7 of fever without other explanation should undergo

lab testing and, if evidence of systemic inflammation is found, an echocardiogram,

even if they have no clinical criteria.
3. Check for classic findings
4. Supplemental lab criteria: Albumin ≤3.0 g/dL, anemia for age, elevation of ALT,

platelets after 7 d ≥450,000/mm3, WBC ≥15,000/mm3, and urine ≥10 WBC/hpf
5. Can treat before performing echocardiogram.
6. Echo is considered positive for purposes of this algorithm if any of 3 conditions

met: z score of LAD or RCA ≥2.5, coronary arteries meet Japanese Ministry of

Health criteria for aneurysms, or ≥3 other suggestive features exist, including

perivascular brightness, lack of tapering, decreased LV function, mitral

regurgitation, pericardial effusion, or z scores in LAD or RCA of 2–2.5.
7. If echo is positive, treatment should be given to children within 10 d of fever onset

and those >day 10 with clinical and lab signs (CRP, ESR) of ongoing inflammation.
8. Typical peeling begins under nail bed of fingers and then toes.


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