Emergency: requires immediate attention
Kawasaki disease - Oral Mucosal Lesion
See also in: Overview,External and Internal Eye,AnogenitalAlerts and Notices
Synopsis

- Conjunctival injection without exudate
- Red lesions of the mouth or pharynx
- Acute hand and foot edema followed by peeling
- Polymorphous cutaneous eruption
- Lymphadenopathy (usually cervical)
Most individuals affected by KD follow a benign disease course. However, coronary artery aneurysms develop in 20%-25% of untreated patients. Treatment is aimed at decreasing the risk of developing coronary artery abnormalities and preventing complications from these abnormalities.
A multisystem inflammatory syndrome potentially linked to COVID-19 has been reported in children and young adults; clinical features include Kawasaki-like and toxic shock syndrome-like presentations.
Codes
ICD10CM:M30.3 – Mucocutaneous lymph node syndrome [Kawasaki]
SNOMEDCT:
75053002 – Kawasaki disease
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Multisystem inflammatory syndrome in children (MIS-C)
- Patients with toxic shock syndrome most often have focal cutaneous skin infections, abscesses, infections associated with nasal packing, or a history of recent surgical procedures.
- COVID-19
- Erythema multiforme presents with symmetrically distributed target lesions. Patients frequently have coexisting herpes orolabialis.
- Reactive infectious mucocutaneous eruption (RIME) – Characterized by prominent mucositis and a sparse eruption that may be polymorphous in association with underlying Mycoplasma pneumoniae or other infection.
- Viral exanthems like measles may be difficult to distinguish from KD. However, patients with measles often display an exudative conjunctivitis and Koplik spots within the oral mucosa.
- The cutaneous and mucosal findings in scarlet fever may also easily be confused with KD. However, these patients respond to anti-streptococcal antibiotic therapy.
- Staphylococcal scalded skin syndrome presents with erythema and desquamation accentuated within skin folds.
- Distinguishing drug reactions (eg, Stevens-Johnson syndrome) from KD can be difficult. A careful drug history is critical.
- KD can present with red cheeks, as does fifth disease (erythema infectiosum). Premature closure on fifth disease leading to missing KD is a diagnostic pitfall.
- For oral findings, also consider hand-foot-and-mouth disease, stomatitis (contact, aphthous), and candidiasis.
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References
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Last Reviewed:08/08/2018
Last Updated:12/11/2022
Last Updated:12/11/2022
Emergency: requires immediate attention
Kawasaki disease - Oral Mucosal Lesion
See also in: Overview,External and Internal Eye,Anogenital