Evidence-Based Management of Kawasaki Disease in the Emergency Department (Pharmacology CME and Risk Management CME)

Publication Date: November 2026 (Volume 23, Number 11)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 11/01/2029.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 0.5 Pharmacology and 0.5 Risk Management CME credits, subject to your state and institutional approval.

Authors

Amanda Lee, MD

Assistant Professor, Department of Emergency Medicine, Section of Pediatric Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, Pediatric Emergency Medicine Fellow, Children’s Minnesota, Minneapolis, MN

Kara K. Seaton, MD, FAAP

Assistant Professor, Department of Emergency Medicine, Section of Pediatric Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, Fellowship Director, Pediatric Emergency Medicine, Children’s Minnesota, Minneapolis, MN

Abstract

Kawasaki disease is currently the leading cause of acquired heart disease in children in developed countries. Signs and symptoms of Kawasaki disease may mimic other childhood illnesses, making it difficult to diagnose, especially in children who present with an incomplete form of the disease. Untreated Kawasaki disease may lead to the formation of coronary artery aneurysms and sudden cardiac death. Emergency clinicians should consider Kawasaki disease in pediatric patients presenting with prolonged fever, as prompt evaluation and management can significantly decrease the risk for serious cardiac sequelae. This review discusses the presentation, diagnostic criteria, and management of Kawasaki disease in the emergency department.

Case Presentations

CASE 1

A 3-year-old girl presents for evaluation of fever...

The mother tells you the girl has had a fever for the past 4 days, with temperatures ranging from 101°F (38.3°C) to 104°F (40°C). She says the child has had a runny nose but no cough, and that she has been complaining of abdominal pain. The girl was evaluated at her pediatrician’s office 2 days ago, and she was diagnosed with a viral illness. The mother reports subsequent development of a red rash that started on the child’s face and chest, and it is now present on her trunk, back, and extremities.
On examination, the girl’s eyes are injected bilaterally, without purulent discharge. She has dry, fissured lips. Her skin is notable for a fine, erythematous, maculopapular rash on the face, chest, back, and extremities. She also has swelling of her hands.
The patient’s ill appearance and history of prolonged fever are concerning for the possibility of Kawasaki disease. What should be the next steps for the management of this patient?

CASE 2

A 4-month-old boy presents for a rash…

The father explains that the boy has had a fever for the past 5 days. He tells you the boy had red eyes 3 days ago, but that has since resolved.
On examination, the child is tired appearing, with a full-body erythematous rash and swollen red hands and feet. He is febrile on initial presentation.
You are concerned for Kawasaki disease but are not sure he meets all of the criteria. What are your next steps in the management of this patient? What are potential complications if he is left untreated?

CASE 3

A 2-year-old boy presents for 5 days of fever...

On examination, he has unilateral cervical lymphadenopathy with a fine, erythematous rash on the torso and extremities. Blood work is performed, including a complete blood cell count, inflammatory markers, and liver function tests, which are all unremarkable.
What should be the next steps for the management of this patient? Should the patient be sent home? If so, what return precautions need to be given?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Evidence-Based Management of Kawasaki Disease in the Emergency Department (Pharmacology CME and Risk Management CME)

Abstract

Case Presentations

Accreditation:

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