KD Clinical Presentation

Micropustular rash of Kawasaki disease with petechiae. This unusual rash is uncommon but is quite specific for Kawasaki disease. Tiny micropustules can be see when a beam of light is shined tangentially across the skin.
Characteristic bilateral, non-exudative conjunctivitis associated with KD. Note the perilimbal sparing with a halo of white around the iris. Conjunctival biopsy in these patients reveals surprisingly little pathology and no cellular response in the epithelium. Keratitis is seen in the minority of patients. The dry conjunctivitis of KD is virtually pathognomonic for this systemic vasculitis. The conjunctivitis is distinguished from viral conjunctivitis caused by enterovirus, measles, and adenovirus by the lack of exudate, absence of keratitis, and absence of keratitic precipitates.
Changes in the extremities. Note the diffuse, non-pitting edema of the dorsum of the foot. This swelling is uncomfortable and patients will refuse to walk. Arthritis in the hip and knee joints may also contribute to stiffness and a reluctance to bear weight.
Swelling of the dorsum of the hand associated with fusiform swelling of the digits. Erythema of the PIP and DIP joints suggests small joint arthritis.
Diffuse erythema of the palm. This finding is usually bilateral and may fluctuate in intensity with the height of the fever. Unlike the rash on other parts of the body, there is no pattern to the erythema.
Accentuation of rash in groin associated with desquamation during acute Kawasaki disease.
Characteristic "strawberry tongue" of KD. The essential components of a strawberry tongue are 1) the sloughing of the filiform papillae due to the systemic inflammatory process and 2) persistence of the fungiform papillae, which form the "seeds" of the strawberry. The strawberry tongue is also associated with both streptococcal and staphylococcal toxin-mediated disease and is not specific to KD.
Diffuse sole erythema
Accentuated groin rash in a circumcised male patient. Note the erythema of the urethral meatus and desquamation of the scrotum. Accentuation of the rash in the groin is seen during the acute phase in 50% of KD patients. This groin accentuation is also typical of scarlet fever and toxic shock. Peeling of the rash in the groin may be marked during the first week of illness and precedes the periungual peeling of the digits.
Erythema of lips

For more information, contact Dr. Jane Burns at 858-246-0155 or email: jcburns@ucsd.edu